Dear Senator Feinstein:
Thank you very much for responding to my email supporting health care reform.
For the record, I am a board certified medical psychologist and pain management specialist practicing in Los Angeles since 1972. I along with many of my colleagues (most on staff at Cedars Sinai, Brotman Medical Center, and Olympia Hospital) support health care reform.
More importantly we support insurance reform. It is admirable to pass legislation prohibiting insurance companies to deny coverage. However, that will not reduce the cost of care.
I have been practicing for 37 years and I believe the only cost cutting device is COMPETITION. If insurance companies had to compete with a public option, if providers had to compete for patients, the cost of health care would plummet.
Further, treating health care as a commodity like we do pork bellies and General Electric is flat out wrong. Corporations must make a profit. Health insurance companies make a profit from sick or injured people. There is somethng terribly and inherently wrong with this picture. Moreover, the profits by insurance companies are significantly increased by denying coverage or delaying treatment. These health insurance companies should be held accountable for the tens of thousands of people in the US who die each year for lack of coverage.
There are other changes that also need to take place to fix our broken health care system. Medicare rules MUST change. Using the CMS reimbursement as a base is fine, but the rule must allow for provider and patient to negotiate balances as opposed to forcing the provider to accept assignment. This will also result in cost containment because the patient will know prior to receiving health care what their out of pocket expense will be. Since providers will have to compete for patients, patients will benefit from this change in rules. The net effect of changing Medicare would be to put the health care decision making where it belongs; between provider and patient. Further, this change would put free enterprise back into medicine.
There must be changes in Tort law as well. Frivolous lawsuits should be disallowed with a mandate to the insurance companies to lower the premiums to providers.
The pharmaceutical and medical device companies also need reform. Two weeks ago we performed a neurostimulator implant surgery at our Los Angeles ambulatory surgery center. Our cost for the neurostimulator was $25,000. I would be willing to bet that the cost of manufacturing the device is less than $2500.
I can provide you with many examples and invoices from surgery equipment and supply vendors revealing the inflated and obscene charges from these companies. There is NO accountability and very little if any competition. These companies have been getting away with these outrageous charges since the early 1980's. Our elected representatives accept campaign contributions from all of these companies. I believe this is a major and significant reason why our health care system is broken.
As you well know, the drug companies are just as bad. Same drug, same manufacturer will sell for 10 times less in Canada or Mexico or any other country in the world than in the USA. The pharmaceutical and medical device companies drive the pricing in health care and it is time for you and your colleagues to STOP them. The only reason they get away with robbery is that we are the ONLY country in the industrialized world that does not have universal health care for their people.
You want to ensure access to health care to all of your constituents? You want to drive health care costs DOWN? You only need to look at the insurance industry, pharmaceutical industry, medical device industry and congress protecting them to make that happen. The solution is a lot simpler than you and your colleagues make it out to be.
Do you have the courage to take on the insurance companies? Pharmaceutical companies? Medical Device companies? You would make all Californians proud if you took them on.
I think it would be very beneficial for you to look at the New Zealand health care system. It is a combination of public and private health care that really works.
My colleagues and I are available to discuss any of these issues with you or your staff, and thank you for listening.
Howard Stanley Rubin, MP PhD
Chief Executive Officer
Museum Center Surgery Group, Inc.
Los Angeles, California
http://healthcarenow-doc.blogspot.com/
Tuesday, September 29, 2009
KAISER SURVEY FINDS INCREASED PUBLIC SUPPORT FOR HEALTH CARE AND INSURANCE REFORM
NEWS RELEASE
Tuesday, September 29, 2009
Public Support For Health Reform Increases in September, Reversing Summer Declines as Congress Takes Up Legislation
Survey Finds Support For New Proposals For Fees And Taxes on Insurance Companies to Help Pay For Overhaul
CONTACTS
Chris Lee(202) 347-5270CLee@kff.org
Rakesh Singh(650) 854-9400RSingh@kff.org
MENLO PARK, CA -- Public support for health reform ended its summer slide, reversed course and moved modestly upwards in September, according to the latest Kaiser Health Tracking Poll.
Fifty-seven percent of Americans now believe that tackling health care reform is more important than ever -- up from 53 percent in August. The proportion of Americans who think their families would be better off if health reform passes is up six percentage points (42% versus 36% in August), and the percentage who think that the country would be better off is up eight points (to 53% from 45% in August).
Despite the uptick, a substantial share of the public (47%) favors taking longer to work out a bipartisan approach to health reform, compared to 42 percent who would prefer to see Democrats move faster on their own. Meanwhile, the public continues to view the action in Washington with mixed feelings: The largest share (68%) said they were "hopeful" about reform, but 50% are "anxious" and 31% "angry."
"Opinion in the coming months is hard to predict, but as the focus shifted from the town halls and hot button issues to the President, the Congress and the core issues in the legislation that affect people the most, the summer downturn in support was largely erased," said Kaiser President and CEO Drew Altman.
Upswing in Support Driven by Changes Among Republicans and Independents
Republicans and political independents became markedly more pessimistic about health reform in August, but those viewpoints softened in September. While 49 percent of Republicans say their family would be worse off if health reform passes, this is down from 61 percent in August.
The percentage of independents saying they would be worse off fell from 36 percent in August to 26 percent this month.
Democrats remain overwhelmingly in favor of tackling health care now (77%), while most Republicans say we cannot afford to do so (63%) and independents are more evenly divided (51% in favor and 44% opposed).
Fifty-seven percent of the public -- including 56% of independents -- say the GOP is opposing reform plans more for political reasons than because they think reform will be bad for the country.
Majority Backing Seen for Taxing Expensive Health Plans and Imposing Fees on Insurers to Pay for Reform
Substantial majorities of Americans continue to say they back individual reform components designed to expand coverage, including an individual mandate (68%), an employer mandate (67%) and an expansion of state programs such as Medicaid and the Children’s Health Insurance Program (82%).
The component that draws among the strongest support across the political spectrum is requiring that health insurance companies cover anyone who applies, even if they are sick or have a pre-existing condition. Overall, 8 in 10 people support that idea, including 67 percent of Republicans, 80 percent of independents and 88 percent of Democrats.
When it comes to paying for reform, two ideas now under discussion among policymakers garner initial majority support. Fifty-seven percent of the public say they would support "having health insurance companies pay a fee based on how much business they have" and 59 percent would support "having health insurance companies pay a tax for offering very expensive policies." In both cases, Republicans are evenly divided while Democrats and political independents tilt in favor. The poll did not test arguments for and against the policies.
Messages Matter
People say they would be more likely to support a new reform proposal if they heard it would:
Improve health care for our children and grandchildren (77%);
Provide financial help to buy health insurance to those who need it (74%);
Help ensure the long-term financial health of Medicare (69%);
Fulfill a moral obligation by ensuring that people don’t have to go without needed health care just because they can’t afford it (68%); and
Mean that people with a history of illness would not be denied coverage and could get it at the same price as healthier people (65%).
Conversely, people say they would be less likely to support a new reform proposal if they heard that it would:
Limit choice of doctors (65%);
Reduce the quality of care provided to seniors under Medicare (63%);
Result in payment cuts that might make doctors less willing to take Medicare patients (62%);
Get the government too involved in your personal health care decisions (59%);
and Increase people’s insurance premiums or other out-of-pocket costs (57%).
Seniors Are Still Less Convinced Reform Will Benefit Them
Seniors are still less convinced than others that health reform will benefit them, but they too have become less pessimistic since August. The share of seniors who think their family would be better off if reform passes climbed 8 percentage points from August, from 23 percent to 31 percent. Twenty-eight percent thought they would be worse off, and 33 percent said it wouldn’t make a difference. Fifty-five percent of seniors said they were 'confused."
Some commentators believe that proposals to obtain savings in the Medicare program are driving opposition among seniors. The survey finds that a plurality of seniors (49%) opposed the idea of limiting future increases in Medicare provider payments as a way to help pay for health care reform. But a solid majority (59%) would back the same limits if they were framed as helping to "keep Medicare financially sound in the future."
"Some Medicare changes being discussed in the health reform debate can be seen as strengthening Medicare for the long-term or as harming it. Which of these messages breaks through could ultimately shape seniors’ reactions," said Mollyann Brodie, vice president for Public Opinion and Survey Research at the Kaiser Family Foundation.
Many Say News Coverage Has Focused on Politics and Controversy
Health reform is the top story out of Washington, with news organizations ramping up coverage in recent months. In assessing the job of the media, 50 percent of the public says news coverage of health reform "has been mostly about politics and controversies," while eight percent say it has been mostly about "how policy reforms might affect your own family." Thirty-seven percent view the coverage as a balance of the two.
Fifty-four percent of the public report that they had seen an ad in the last seven days that had to do with proposed changes in the health care system, up from 45 percent in August and 21 percent in June. The public says that these ads have come fairly evenly from proponents and opponents of reform.
Americans Continue to Struggle with Unaffordable Health Care While policymakers debate solutions, the problem of high health care costs remains. One third of Americans (33%) say they or someone in their household has had problems paying medical bills over the past year. That is up nine percentage points from August and represents the highest level this measure has reached in nearly a year.
A majority of Americans (56%) also say they have put off care over the last 12 months because of cost reasons, with many saying that they had relied on home remedies or over the counter drugs instead of seeing a doctor (44%), skipped dental care or other checkups (35%), or skipped a recommended medical test or treatment (28%).
Methodology
The survey was designed and analyzed by public opinion researchers at the Kaiser Family Foundation and was conducted September 11 through September 18, 2009, among a nationally representative random sample of 1,203 adults ages 18 and older. Telephone interviews conducted by landline (801) and cell phone (402, including 147 who had no landline telephone) were carried out in English and Spanish. The margin of sampling error for the total sample is plus or minus 3 percentage points. For results based on subgroups, the margin of sampling error is higher.
The full question wording, results, charts and a brief on the poll can be viewed online.
The Kaiser Family Foundation is a non-profit private operating foundation, based in Menlo Park, California, dedicated to producing and communicating the best possible information, research and analysis on health issues.
Tuesday, September 29, 2009
Public Support For Health Reform Increases in September, Reversing Summer Declines as Congress Takes Up Legislation
Survey Finds Support For New Proposals For Fees And Taxes on Insurance Companies to Help Pay For Overhaul
CONTACTS
Chris Lee(202) 347-5270CLee@kff.org
Rakesh Singh(650) 854-9400RSingh@kff.org
MENLO PARK, CA -- Public support for health reform ended its summer slide, reversed course and moved modestly upwards in September, according to the latest Kaiser Health Tracking Poll.
Fifty-seven percent of Americans now believe that tackling health care reform is more important than ever -- up from 53 percent in August. The proportion of Americans who think their families would be better off if health reform passes is up six percentage points (42% versus 36% in August), and the percentage who think that the country would be better off is up eight points (to 53% from 45% in August).
Despite the uptick, a substantial share of the public (47%) favors taking longer to work out a bipartisan approach to health reform, compared to 42 percent who would prefer to see Democrats move faster on their own. Meanwhile, the public continues to view the action in Washington with mixed feelings: The largest share (68%) said they were "hopeful" about reform, but 50% are "anxious" and 31% "angry."
"Opinion in the coming months is hard to predict, but as the focus shifted from the town halls and hot button issues to the President, the Congress and the core issues in the legislation that affect people the most, the summer downturn in support was largely erased," said Kaiser President and CEO Drew Altman.
Upswing in Support Driven by Changes Among Republicans and Independents
Republicans and political independents became markedly more pessimistic about health reform in August, but those viewpoints softened in September. While 49 percent of Republicans say their family would be worse off if health reform passes, this is down from 61 percent in August.
The percentage of independents saying they would be worse off fell from 36 percent in August to 26 percent this month.
Democrats remain overwhelmingly in favor of tackling health care now (77%), while most Republicans say we cannot afford to do so (63%) and independents are more evenly divided (51% in favor and 44% opposed).
Fifty-seven percent of the public -- including 56% of independents -- say the GOP is opposing reform plans more for political reasons than because they think reform will be bad for the country.
Majority Backing Seen for Taxing Expensive Health Plans and Imposing Fees on Insurers to Pay for Reform
Substantial majorities of Americans continue to say they back individual reform components designed to expand coverage, including an individual mandate (68%), an employer mandate (67%) and an expansion of state programs such as Medicaid and the Children’s Health Insurance Program (82%).
The component that draws among the strongest support across the political spectrum is requiring that health insurance companies cover anyone who applies, even if they are sick or have a pre-existing condition. Overall, 8 in 10 people support that idea, including 67 percent of Republicans, 80 percent of independents and 88 percent of Democrats.
When it comes to paying for reform, two ideas now under discussion among policymakers garner initial majority support. Fifty-seven percent of the public say they would support "having health insurance companies pay a fee based on how much business they have" and 59 percent would support "having health insurance companies pay a tax for offering very expensive policies." In both cases, Republicans are evenly divided while Democrats and political independents tilt in favor. The poll did not test arguments for and against the policies.
Messages Matter
People say they would be more likely to support a new reform proposal if they heard it would:
Improve health care for our children and grandchildren (77%);
Provide financial help to buy health insurance to those who need it (74%);
Help ensure the long-term financial health of Medicare (69%);
Fulfill a moral obligation by ensuring that people don’t have to go without needed health care just because they can’t afford it (68%); and
Mean that people with a history of illness would not be denied coverage and could get it at the same price as healthier people (65%).
Conversely, people say they would be less likely to support a new reform proposal if they heard that it would:
Limit choice of doctors (65%);
Reduce the quality of care provided to seniors under Medicare (63%);
Result in payment cuts that might make doctors less willing to take Medicare patients (62%);
Get the government too involved in your personal health care decisions (59%);
and Increase people’s insurance premiums or other out-of-pocket costs (57%).
Seniors Are Still Less Convinced Reform Will Benefit Them
Seniors are still less convinced than others that health reform will benefit them, but they too have become less pessimistic since August. The share of seniors who think their family would be better off if reform passes climbed 8 percentage points from August, from 23 percent to 31 percent. Twenty-eight percent thought they would be worse off, and 33 percent said it wouldn’t make a difference. Fifty-five percent of seniors said they were 'confused."
Some commentators believe that proposals to obtain savings in the Medicare program are driving opposition among seniors. The survey finds that a plurality of seniors (49%) opposed the idea of limiting future increases in Medicare provider payments as a way to help pay for health care reform. But a solid majority (59%) would back the same limits if they were framed as helping to "keep Medicare financially sound in the future."
"Some Medicare changes being discussed in the health reform debate can be seen as strengthening Medicare for the long-term or as harming it. Which of these messages breaks through could ultimately shape seniors’ reactions," said Mollyann Brodie, vice president for Public Opinion and Survey Research at the Kaiser Family Foundation.
Many Say News Coverage Has Focused on Politics and Controversy
Health reform is the top story out of Washington, with news organizations ramping up coverage in recent months. In assessing the job of the media, 50 percent of the public says news coverage of health reform "has been mostly about politics and controversies," while eight percent say it has been mostly about "how policy reforms might affect your own family." Thirty-seven percent view the coverage as a balance of the two.
Fifty-four percent of the public report that they had seen an ad in the last seven days that had to do with proposed changes in the health care system, up from 45 percent in August and 21 percent in June. The public says that these ads have come fairly evenly from proponents and opponents of reform.
Americans Continue to Struggle with Unaffordable Health Care While policymakers debate solutions, the problem of high health care costs remains. One third of Americans (33%) say they or someone in their household has had problems paying medical bills over the past year. That is up nine percentage points from August and represents the highest level this measure has reached in nearly a year.
A majority of Americans (56%) also say they have put off care over the last 12 months because of cost reasons, with many saying that they had relied on home remedies or over the counter drugs instead of seeing a doctor (44%), skipped dental care or other checkups (35%), or skipped a recommended medical test or treatment (28%).
Methodology
The survey was designed and analyzed by public opinion researchers at the Kaiser Family Foundation and was conducted September 11 through September 18, 2009, among a nationally representative random sample of 1,203 adults ages 18 and older. Telephone interviews conducted by landline (801) and cell phone (402, including 147 who had no landline telephone) were carried out in English and Spanish. The margin of sampling error for the total sample is plus or minus 3 percentage points. For results based on subgroups, the margin of sampling error is higher.
The full question wording, results, charts and a brief on the poll can be viewed online.
The Kaiser Family Foundation is a non-profit private operating foundation, based in Menlo Park, California, dedicated to producing and communicating the best possible information, research and analysis on health issues.
Friday, September 25, 2009
Called out on Miracles
I received this response to yesterday's Blog. Following are the criticism and my response. It would be great to hear from more of you. This issue effects ALL OF US.
There is one thing I'm having a hard time understanding about your (and many liberals' views)....you all want a 'public option' under the guise of increased competition to the insurance companies. But in the next sentence want a single payor system, which would ELIMINATE any competition. You guys should at least be honest and say that you want a public option as a means to eliminate the insurance companies.
Response
What I WANT and what is currently possible are two different things. If you read the blog again, you will find that I was answering a question about what a public option would look like based on my understanding of what is being considered by Congress. In this context, a public option would go a long way in driving costs down due to competition for policy holders and provider competition for patients.
I then addressed the issue of how health care is perceived and understood in the United States. UNFORTUNATELY, we view health care as a commodity or equity like we do pork bellies or General Electric. We are the only industrialized country in the world that views health care this way. In other words, health insurance corporations must profit at the expense of sick or injured people. They do this by denying or delaying treatment, or canceling policies AFTER the policy holder contracts a serious or catastrophic disease. There is something terribly wrong with that picture.
If our government created laws that did not allow profiteering off the sick or injured, health insurance companies would no longer exist. I think that not profiting from a human beings misery is a good thing. Universal health care in other countries is NON PROFIT, paid by tax dollars. That's right, tax dollars.
These countries have NO problem with taking care of their people, unlike us AMERICANS. I have heard so many people talk negatively about single payor system or even a public option because they don't want to pay for other peoples health care. Fact is we are all ready paying for other peoples health care. Those of us lucky enough to be employed pay taxes for Medicare. We are paying NOW for our health care later. We are paying NOW for those 65 or older, or who are disabled. That argument that "I shouldn't have to or don't want to pay for others health care" is shortsighted and WRONG. If this position is liberal, I am guilty.
I have some questions for those of you who actually believe that it is everyone for themselves.
If the US was attacked with biological weapons and you or a family member contracted a serious disease because of this attack; would you want to be obligated to obtain pre certification from your insurance company to be treated? Would you want to subject yourself to their scrutiny and review of your medical history? What if they determined that your policy was not valid because you forgot to document that you were treated for acne when you were a teenager so many years ago? What would you do if your insurance company denied your claim because they determined it was a pre existing condition? What if you had a $5000 deductible and didn't have the money? What if this disease prohibited you from earning a living and you didn't have your $50 co-pay?
My guess is that you wouldn't have any problem with this since your belief is that we should only have to take care of ourselves. I'm certain you would rather suffer in your illness than be treated for it.
There is one thing I'm having a hard time understanding about your (and many liberals' views)....you all want a 'public option' under the guise of increased competition to the insurance companies. But in the next sentence want a single payor system, which would ELIMINATE any competition. You guys should at least be honest and say that you want a public option as a means to eliminate the insurance companies.
Response
What I WANT and what is currently possible are two different things. If you read the blog again, you will find that I was answering a question about what a public option would look like based on my understanding of what is being considered by Congress. In this context, a public option would go a long way in driving costs down due to competition for policy holders and provider competition for patients.
I then addressed the issue of how health care is perceived and understood in the United States. UNFORTUNATELY, we view health care as a commodity or equity like we do pork bellies or General Electric. We are the only industrialized country in the world that views health care this way. In other words, health insurance corporations must profit at the expense of sick or injured people. They do this by denying or delaying treatment, or canceling policies AFTER the policy holder contracts a serious or catastrophic disease. There is something terribly wrong with that picture.
If our government created laws that did not allow profiteering off the sick or injured, health insurance companies would no longer exist. I think that not profiting from a human beings misery is a good thing. Universal health care in other countries is NON PROFIT, paid by tax dollars. That's right, tax dollars.
These countries have NO problem with taking care of their people, unlike us AMERICANS. I have heard so many people talk negatively about single payor system or even a public option because they don't want to pay for other peoples health care. Fact is we are all ready paying for other peoples health care. Those of us lucky enough to be employed pay taxes for Medicare. We are paying NOW for our health care later. We are paying NOW for those 65 or older, or who are disabled. That argument that "I shouldn't have to or don't want to pay for others health care" is shortsighted and WRONG. If this position is liberal, I am guilty.
I have some questions for those of you who actually believe that it is everyone for themselves.
If the US was attacked with biological weapons and you or a family member contracted a serious disease because of this attack; would you want to be obligated to obtain pre certification from your insurance company to be treated? Would you want to subject yourself to their scrutiny and review of your medical history? What if they determined that your policy was not valid because you forgot to document that you were treated for acne when you were a teenager so many years ago? What would you do if your insurance company denied your claim because they determined it was a pre existing condition? What if you had a $5000 deductible and didn't have the money? What if this disease prohibited you from earning a living and you didn't have your $50 co-pay?
My guess is that you wouldn't have any problem with this since your belief is that we should only have to take care of ourselves. I'm certain you would rather suffer in your illness than be treated for it.
Thursday, September 24, 2009
Do you believe in Miracles?
The following letter is in response to a question I was asked in regard to what a "public option" would be like. More specifically, I was asked if the public option was going to be like Medicare.
Sorry it has taken me so long to respond to your question. I have been very busy at the surgery center. My understanding is that the "public option" is one of several health insurance products that will be made available to individuals and small business that currently don't have or provide health insurance. The details have not been fully worked out, but I think the end product will be similar to Medicare in that the government will "outsource" the administration of the public plan to a third party as it currently does for Medicare. Hopefully, that will be the only similarity.
There will need to be some major changes in the current Medicare system to make a public option viable. I have outlined many of the necessary changes in previous posts on the Blog Health Care NOW. Specifically, reimbursement must be increased in order for providers to accept patients participating in the public option, and payroll decutions must be increased to pay for the public option.
One method of increasing reimbursement is to allow providers and their patients negotiate balances. I have suggested a two pronged approach where the current CMS reimbursement is increased 15--20% AND the difference between the providers fee and CMS reimbursement is negotiated with the patient PRIOR to the delivery of the health care service or procedure.
Further, an increase in the Medicare payroll deduction must also take place. This increase should be 10--15%. This increase pales in comparison to deductibles and co-payments currently in existence. This is doable since worker's and self employed people will have choices for their health insurance products and costs will decrease naturally with competition.
This is also true for the NON public plan options. Competition will drive the costs down because providers as well as insurance companies will be competing for patients and policy holders.
One other thing of note. Unfortunately, in the USA, health care is treated as a commodity. It shouldn't be, but it is. If this attitude were to change, private insurance companies would go out of the health care business which would be the best thing ever to happen in health care. It is the insurance industry along with the pharmaceutical companies and medical device companies that are raping the system. These are private companies that must be accountable to shareholders.
That means they MUST make money. This has been the case since the 1970s and at the expense of the patient and provider. Remove the necessity to make corporate profits off of health care and that money can be used to PROVIDE HEALTH CARE. Further, the costs would plummet since there would be NO health insurance premiums, no costly utilization review, no denial of health care, no delay of obtaining health care, no fighting for reimbursement, all of which costs billions. Further, denial often times ends in death, and delay ends up costing more than if treatment were authorized when requested. Remove all this nonsense, and we would all be healthier and health care costs would be significantly reduced.
Remember, health insurance companies DO NOT PROVIDE HEALTH CARE. They broker health care which is a nice way of saying they are pimps for executives and shareholders.
Tort reform should also drive down some of the cost and needs to be looked at carefully. There is not a lot of evidence showing that tort reform will reduce mal practice insurance premiums. Again, the insurance companies must make a profit and they will sell anything at the highest price they can get. No regulation is equal to highway robbery for the insurance industry. Only competition will drive down the costs of mal practice insurance.
The result of removing corporations from the health care system would be a single payor system in the USA. We are the only industrialized country in the world that does NOT have this for all of their citizens. Personally, I think that is shameful that people go bankrupt because one major illness cost them their life savings and assets in the wealthiest industrialized country in the world. This is ONLY because corporations must make a profit on health care.
Should be an interesting next couple of weeks. The senate finance committee should have legislation ready to present to the senate in a few days. I just hope our president has the balls to stand up to special interest, conservative democrats, and republicans on this issue.
Sorry it has taken me so long to respond to your question. I have been very busy at the surgery center. My understanding is that the "public option" is one of several health insurance products that will be made available to individuals and small business that currently don't have or provide health insurance. The details have not been fully worked out, but I think the end product will be similar to Medicare in that the government will "outsource" the administration of the public plan to a third party as it currently does for Medicare. Hopefully, that will be the only similarity.
There will need to be some major changes in the current Medicare system to make a public option viable. I have outlined many of the necessary changes in previous posts on the Blog Health Care NOW. Specifically, reimbursement must be increased in order for providers to accept patients participating in the public option, and payroll decutions must be increased to pay for the public option.
One method of increasing reimbursement is to allow providers and their patients negotiate balances. I have suggested a two pronged approach where the current CMS reimbursement is increased 15--20% AND the difference between the providers fee and CMS reimbursement is negotiated with the patient PRIOR to the delivery of the health care service or procedure.
Further, an increase in the Medicare payroll deduction must also take place. This increase should be 10--15%. This increase pales in comparison to deductibles and co-payments currently in existence. This is doable since worker's and self employed people will have choices for their health insurance products and costs will decrease naturally with competition.
This is also true for the NON public plan options. Competition will drive the costs down because providers as well as insurance companies will be competing for patients and policy holders.
One other thing of note. Unfortunately, in the USA, health care is treated as a commodity. It shouldn't be, but it is. If this attitude were to change, private insurance companies would go out of the health care business which would be the best thing ever to happen in health care. It is the insurance industry along with the pharmaceutical companies and medical device companies that are raping the system. These are private companies that must be accountable to shareholders.
That means they MUST make money. This has been the case since the 1970s and at the expense of the patient and provider. Remove the necessity to make corporate profits off of health care and that money can be used to PROVIDE HEALTH CARE. Further, the costs would plummet since there would be NO health insurance premiums, no costly utilization review, no denial of health care, no delay of obtaining health care, no fighting for reimbursement, all of which costs billions. Further, denial often times ends in death, and delay ends up costing more than if treatment were authorized when requested. Remove all this nonsense, and we would all be healthier and health care costs would be significantly reduced.
Remember, health insurance companies DO NOT PROVIDE HEALTH CARE. They broker health care which is a nice way of saying they are pimps for executives and shareholders.
Tort reform should also drive down some of the cost and needs to be looked at carefully. There is not a lot of evidence showing that tort reform will reduce mal practice insurance premiums. Again, the insurance companies must make a profit and they will sell anything at the highest price they can get. No regulation is equal to highway robbery for the insurance industry. Only competition will drive down the costs of mal practice insurance.
The result of removing corporations from the health care system would be a single payor system in the USA. We are the only industrialized country in the world that does NOT have this for all of their citizens. Personally, I think that is shameful that people go bankrupt because one major illness cost them their life savings and assets in the wealthiest industrialized country in the world. This is ONLY because corporations must make a profit on health care.
Should be an interesting next couple of weeks. The senate finance committee should have legislation ready to present to the senate in a few days. I just hope our president has the balls to stand up to special interest, conservative democrats, and republicans on this issue.
Tuesday, September 22, 2009
Friday, September 18, 2009
Study links 45, 000 U.S. deaths to lack of insurance
WASHINGTON (Reuters) – Nearly 45,000 people die in the United States eachyear -- one every 12 minutes -- in large part because they lack healthinsurance and can not get good care, Harvard Medical School researchersfound in an analysis released on Thursday."We're losing more Americans every day because of inaction ... than drunkdriving and homicide combined,"
Dr. David Himmelstein, a co-author of thestudy and an associate professor of medicine at Harvard, said in aninterview with Reuters.Overall, researchers said American adults age 64 and younger who lack healthinsurance have a 40 percent higher risk of death than those who havecoverage.
The findings come amid a fierce debate over Democrats' efforts to reform the nation's $2.5 trillion U.S. healthcare industry by expanding coverage and reducing healthcare costs. President Barack Obama has made the overhaul a top domestic policy priority, but his plan has been besieged by critics and slowed by intense political battles in Congress, with the insurance and healthcare industries fighting some parts of the plan.
The Harvard study, funded by a federal research grant, was published in the online edition of the American Journal of Public Health. It was released by Physicians for a National Health Program, which favors government-backed or "single-payer" health insurance.
A similar study in 1993 found those without insurance had a 25 percentgreater risk of death, according to the Harvard group. The Institute of Medicine later used that data in its 2002 estimate showing about 18,000 people a year died because they lacked coverage. Part of the increased risk now is due to the growing ranks of the uninsured, Himmelstein said. Roughly 46.3 million people in the United States lacked coverage in 2008, the U.S. Census Bureau reported last week, up from 45.7 million in 2007.
Another factor is that there are fewer places for the uninsured to get good care. Public hospitals and clinics are shuttering or scaling back across the country in cities like New Orleans, Detroit and others, he said. Study co-author Dr. Steffie Woolhandler said the findings show that without proper care, uninsured people are more likely to die from complications associated with preventable diseases such as diabetes and heart disease.
Some critics called the study flawed. The National Center for Policy Analysis, a Washington think tank that backs a free-market approach to health care, said researchers overstated the death risk and did not track how long subjects were uninsured. Woolhandler said that while Physicians for a National Health Program supports government-backed coverage, the Harvard study's six researchers closely followed the methodology used in the 1993 study conducted by researchers in the federal government as well as the University of Rochester in New York.
The Harvard researchers analyzed data on about 9,000 patients tracked by the U.S. Centers for Disease Control and Prevention's National Center for HealthStatistics through the year 2000. They excluded older Americans because those aged 65 or older are covered by the U.S. Medicare insurance program."For any doctor ... it's completely a no-brainer that people who can't get health care are going to die more from the kinds of things that health careis supposed to prevent," said Woolhandler, a professor of medicine atHarvard and a primary care physician in Cambridge, Massachusetts.
Dr. David Himmelstein, a co-author of thestudy and an associate professor of medicine at Harvard, said in aninterview with Reuters.Overall, researchers said American adults age 64 and younger who lack healthinsurance have a 40 percent higher risk of death than those who havecoverage.
The findings come amid a fierce debate over Democrats' efforts to reform the nation's $2.5 trillion U.S. healthcare industry by expanding coverage and reducing healthcare costs. President Barack Obama has made the overhaul a top domestic policy priority, but his plan has been besieged by critics and slowed by intense political battles in Congress, with the insurance and healthcare industries fighting some parts of the plan.
The Harvard study, funded by a federal research grant, was published in the online edition of the American Journal of Public Health. It was released by Physicians for a National Health Program, which favors government-backed or "single-payer" health insurance.
A similar study in 1993 found those without insurance had a 25 percentgreater risk of death, according to the Harvard group. The Institute of Medicine later used that data in its 2002 estimate showing about 18,000 people a year died because they lacked coverage. Part of the increased risk now is due to the growing ranks of the uninsured, Himmelstein said. Roughly 46.3 million people in the United States lacked coverage in 2008, the U.S. Census Bureau reported last week, up from 45.7 million in 2007.
Another factor is that there are fewer places for the uninsured to get good care. Public hospitals and clinics are shuttering or scaling back across the country in cities like New Orleans, Detroit and others, he said. Study co-author Dr. Steffie Woolhandler said the findings show that without proper care, uninsured people are more likely to die from complications associated with preventable diseases such as diabetes and heart disease.
Some critics called the study flawed. The National Center for Policy Analysis, a Washington think tank that backs a free-market approach to health care, said researchers overstated the death risk and did not track how long subjects were uninsured. Woolhandler said that while Physicians for a National Health Program supports government-backed coverage, the Harvard study's six researchers closely followed the methodology used in the 1993 study conducted by researchers in the federal government as well as the University of Rochester in New York.
The Harvard researchers analyzed data on about 9,000 patients tracked by the U.S. Centers for Disease Control and Prevention's National Center for HealthStatistics through the year 2000. They excluded older Americans because those aged 65 or older are covered by the U.S. Medicare insurance program."For any doctor ... it's completely a no-brainer that people who can't get health care are going to die more from the kinds of things that health careis supposed to prevent," said Woolhandler, a professor of medicine atHarvard and a primary care physician in Cambridge, Massachusetts.
Wednesday, September 16, 2009
We're number 37
Wealthiest nation in the world but only 37 on the World Health Organizations List of best health care. Check it out
http://www.youtube.com/watch?v=yVgOl3cETb4
http://www.youtube.com/watch?v=yVgOl3cETb4
Tuesday, September 15, 2009
The Health Insurance Racket: Getting Rich by Denying Care
As previously discussed, health insurance companies profit by denying or delaying care. People who have paid insurance premiums do NOT get the care they need. This is why a public option must be part of Health Care reform. Write or call your congresspersons and senators. This is the most important issue of our time. Get active and do something about it. Visit www.sickforprofit.com to watch video and make sure you share it with your family and friends.
Thursday, September 10, 2009
Employer based Health Insurance: A major source of anxiety
The Secretary of Health and Human Services is releasing a new report today that shows significant insecurity among workers who receive health insurance through their employers. "Millions of Americans depend on their job for health benefits, but more and more of these families have seen their coverage disappear," writes Jeanne Lambrew, Director, HHS Office of Health Reform.
The Secretary's report notes that "A full one in six Americans with employer-sponsored insurance in 2006 lost that coverage by 2008." This fact is extremely important when you consider 9.75% national unemployment rate. When people lose their jobs, they lose their family health insurance and must seek alternative coverage. Since there are very few insurance company options, and since the insurance companies are motivated by profit, obtaining health insurance for their family costs 60% more than employer funded plans in out of pocket costs for deductibles and co-payments. The report further reveals that almost 75 percent of individuals looking for coverage on the individual market never bought a plan, with 61 percent of those who did not purchase the insurance citing premium cost as the primary reason. This is the health insurance company's way of kicking a person while they are down.
Please visit www.HealthReform.gov and read the complete report. It’s a powerful argument in favor of real reform that will give American families the security and stability they require.
Last night, President Obama spoke to our nation about his health care plan. He pointed out the necessity for reform and attempted to dispel the fictitious ramblings and misinformation generated by Health Care NOW opposition. The opposition will NOT STOP it's effort to defeat Health Care Reform. There is too much money at stake and too much special interest influence to stop the lies, hate mongering, and craziness expressed by the opposition. We, THE PEOPLE, must take responsibility to ensure Health Care NOW. This is a critical time and we are closer to health insurance reform than ever before. Please call, write, or email, your Senators and Congressperson and demand support for Health Care Reform. With your involvement and support, we will make Health Care NOW a reality.
The Secretary's report notes that "A full one in six Americans with employer-sponsored insurance in 2006 lost that coverage by 2008." This fact is extremely important when you consider 9.75% national unemployment rate. When people lose their jobs, they lose their family health insurance and must seek alternative coverage. Since there are very few insurance company options, and since the insurance companies are motivated by profit, obtaining health insurance for their family costs 60% more than employer funded plans in out of pocket costs for deductibles and co-payments. The report further reveals that almost 75 percent of individuals looking for coverage on the individual market never bought a plan, with 61 percent of those who did not purchase the insurance citing premium cost as the primary reason. This is the health insurance company's way of kicking a person while they are down.
Please visit www.HealthReform.gov and read the complete report. It’s a powerful argument in favor of real reform that will give American families the security and stability they require.
Last night, President Obama spoke to our nation about his health care plan. He pointed out the necessity for reform and attempted to dispel the fictitious ramblings and misinformation generated by Health Care NOW opposition. The opposition will NOT STOP it's effort to defeat Health Care Reform. There is too much money at stake and too much special interest influence to stop the lies, hate mongering, and craziness expressed by the opposition. We, THE PEOPLE, must take responsibility to ensure Health Care NOW. This is a critical time and we are closer to health insurance reform than ever before. Please call, write, or email, your Senators and Congressperson and demand support for Health Care Reform. With your involvement and support, we will make Health Care NOW a reality.
Wednesday, September 9, 2009
Health Care Reform: The Assault on Truth
The following article is from AARP Bulletin Today published on August 14, 2009. In less than an hour, President Obama will speak to the nation on Health Care Reform. He will try to dispell the myths and misinformation presented by Health Care Reform opposition, primarily funded by the insrucance industry, pharmaceutical industry, and others who benefit from the status quo. Thank you Ms Barry for attempting to get at the TRUTH
By Patricia Barry:
Now it’s getting down and dirty. As expected, the gloves are off in President Obama’s push for health care reform. Democrats and Republicans are battling over how to fix a system they all agree is broken—that’s how Congress is supposed to work. But this summer something new has entered the political arena—a tsunami of rumors, myths, fear-mongering and misinformation about the proposals that surges around the Internet in nanoseconds. “I’m totally confused about what’s going on,” one reader wrote to the AARP Bulletin. “How do I know who to believe?”
Misinformation spreads at rapid speed
It’s a good question. Another is how this new phenomenon—the ability to spread misleading information at rapid speed through chain e-mails, blogs, text-messaging and “tweets”—will affect the reform debate.
“What we’re seeing is a flood of viral content that distorts the Obama effort to reform health care,” says Kathleen Hall Jamieson, director of the Annenberg Public Policy Center at the University of Pennsylvania, who codirects www.FactCheck.org, a website that examines questionable claims from all sides of the political spectrum.
Today’s opposition tools are very different from those used against previous attempts at health care reform in the Clinton era. Then, the key means of attack available were television advertising and direct-mail campaigns, which were expensive and took time to organize.
“Extremists and people who are so locked into their own ideology that they’ll distort anything have been out there forever,” Jamieson says. “But they haven’t had a way to reach out to as many people as efficiently as they have now.”
Understanding the proposals
Health care reform has “serious consequences to people’s lives, and it would be useful if as many people as possible actually understood what the proposals are about,” Jamieson says. But the rise of the Internet and the decline of the mainstream press as a prime source of information, she adds, put that prospect at risk.
To add to the confusion, Obama, while talking up his overall goals for reform, has left it to Congress to work out the details. The result: a number of committees, each developing and announcing scores of proposals, which change as negotiations progress. “This process has not been a success in garnering public support for reform, and has left people nervous,” says Robert Blendon, professor of health policy and political analysis at Harvard University’s School of Public Health. “So the headlines every day, because the bills are different, scare different people.”
Could the rumormongering affect the outcome? Recent angry exchanges and violent interruptions at lawmakers’ town hall meetings during the August recess suggest that it might. Members of Congress faced a barrage of questions based on the same Internet-spread myths.
If a disproportionate number of constituents who believe the rumors show up at meetings, while those who are happy with health reform stay home, what then? “Does that skew the member’s sense of public opinion?” Jamieson asks. “Does it send the member back [to Washington] saying, ‘I’m going to lose the election if I vote for this thing?’ ”
Blendon, though, thinks most voters, especially the independents, ultimately won’t be swayed by the myths. “The real debate for them is: What happens to me and my family out of this thing?” he says.
As proposals are refined into a single bill, which could happen this fall, Americans will get a better handle on what matters to them—whether their own health care costs would rise or fall under reform, whether taxes would increase to pay for it, and what impact it would have on the deficit, Blendon says.
Meanwhile, here are some of the persistent myths about health care reform, how they arose, and what the three leading current proposals—a House bill, a Senate health committee bill and a set of options still being considered by the Senate Finance Committee—actually say about those issues:
Q. Will the government take over health care so we end up with socialized medicine?
No. Neither the president nor the congressional committees have suggested anything remotely resembling a government takeover of health care.
Obama has specifically rejected the idea of a “single payer” system, like Canada’s, in which the government insures all citizens. None of the leading proposals in Congress even considers going down this road—a fact that has brought strong protests from some consumer and doctor groups that favor this approach. And although Sen. Edward Kennedy, D-Mass., has long called for a “Medicare for All” program, this is not included in proposals from the Senate health committee that he chairs.
Even further off the table is the concept of “socialized medicine”—in which the government not only runs health care but also owns hospitals and pays doctors’ salaries. Great Britain has this kind of setup, as do the Veterans Affairs and Department of Defense health programs in the United States.
Where did this myth come from? Opponents of reform constantly use the term “government-run health care” to disparage the reform proposals, despite the popularity and success of existing government-run programs like Medicare. The tactic often works. Even some Medicare beneficiaries say they’re worried about a “government takeover” of Medicare.
What do the proposals say? Obama has proposed setting up a single “public plan”—available only to those without employer insurance—to provide a voluntary alternative to the many private plans that offer individual health insurance. The House and Senate health committee bills propose a national public plan to compete with these plans and meet the same requirements. The Senate Finance Committee is expected to exclude a public plan. Lawmakers are also considering state-run community health co-ops as an option.
Q. Will private insurance be outlawed or wither on the vine?
No. Obama and the congressional committees say their objective is to build on the current system—keeping employer-sponsored group insurance and giving more consumer protections to people who are employed by small businesses or buy insurance as individuals.
Supporters of a public plan option argue that it would act as a safety net for the uninsured, provide competition for private insurers and, in Obama’s words, “keep them honest.” Opponents of the public option, including the health insurance industry, contend that it would ultimately destroy private insurance because the government could offer lower payment rates to doctors and hospitals, as Medicare now does.
Where did this myth come from? Currently 177 million people have employer or individual insurance. The issue caught fire after the Lewin Group, a research consulting firm owned by UnitedHealth Group, estimated that 119 million of them would switch to a public plan, if everybody were allowed to join it. But the proposals actually exclude those with employer insurance from the public plan. On that basis, the group estimates that 34.9 million would exit private insurance—but it was the high 119 million figure that ricocheted around the Internet.
Another public policy group, the Urban Institute, calculated that after reform, 161 million (or 91 percent) would still enroll in private plans. A third group, the Economic Policy Institute, examined how employers would react to a “pay or play” mandate, which would require them to either provide coverage or contribute up to 8 percent of payroll to cover the uninsured. Fears of a mass exodus from employer insurance “are overblown,” the study found. “Millions of workers will keep the employer-sponsored insurance they have today.”
What do the proposals say? Each of the proposals calls for national or regional heath insurance exchanges that would allow people without employer or public insurance and small employers to choose from a menu of private insurance plans (and a public option, if there is one), with online information to help compare them.
Subsidies would be available for people unable to afford the premiums, on a sliding scale according to income. And under the House bill, people with employer insurance would be eligible for government help if their premiums exceeded 11 percent of their income. Small businesses would also get subsidies.
People with existing insurance would be able to keep it after reform begins. But after that date, new individual policies could no longer be sold unless they met required standards of benefits. After five years, all plans—including group employer insurance—would have to meet those standards.
Q. Will the government encourage euthanasia to save costs?
No. This false but scary idea—now surging around the Internet in blogs and e-mails—claims that the House bill would require Medicare beneficiaries to have mandatory classes every five years to decide how to end their lives earlier. Typical e-mails add: “They’re going to push suicide to cut Medicare spending!” All identify page 425 of the bill as their source.
Where did this myth come from? On July 16, Betsy McCaughey, a former Republican lieutenant governor of New York, appeared on a conservative radio show. Citing page 425, she said: “Congress would make it mandatory … that every five years, people in Medicare have a required counseling session that will tell them how to end their life sooner … all to do what’s in society’s best interest.”
On July 23, Rep. John Boehner of Ohio, leader of the House Republicans, issued a statement saying: “This provision may start us down a treacherous path toward government-encouraged euthanasia if enacted into law.” On Aug. 7, former Alaska governor Sarah Palin described the proposal as setting up a “death panel.”
What does the proposal say? The clause on page 424 (section 1233) would require Medicare to pay doctors for their time if beneficiaries chose to consult them for information on advance care planning, such as making a living will, appointing a health proxy, and hospice care (already covered by Medicare). Medicare would pay for these sessions only once every five years.
AARP described McCaughey’s claims as “rife with gross—and even cruel—distortions” of legislation that “would not only help people make the best decisions for themselves [on end-of-life care], but also better ensure that their wishes are followed.”
Republican Sen. Johnny Isakson of Georgia, who has sponsored a bill that would also allow Medicare to cover end-of-life planning, characterized the death panel talk as “nuts.”
Q. Will Medicare be eliminated or gutted to pay for reform?
No. It’s inconceivable that any lawmaker would commit political suicide by proposing to get rid of Medicare. But the rumor has fast gained ground.
Where did this myth come from? Dick Morris, a political commentator, posted an article on his blog that began: “Obama’s health care proposal is, in effect, the repeal of the Medicare program as we know it.” Morris claimed that the proposals “will totally gut Medicare and replace it with government-managed care and rationing.” His article was picked up within days on some 281,000 websites.
What do the proposals say? It’s true they all seek to save billions from Medicare costs—not by cutting benefits, but by setting up new ways to pay doctors more fairly and to reward providers for quality of care instead of (as now) paying them a fee for each separate service; reducing waste and fraud; and reducing preventable hospital readmissions.
All the proposals would cut the amount of subsidies now paid to Medicare Advantage private health plans, which cost an average of 14 percent more per person than traditional Medicare does. Without subsidies, the private plans could become more efficient, or they could raise premiums, reduce benefits or withdraw from Medicare.
The proposals also add benefits to Medicare—such as covering more preventive services and narrowing the Part D “doughnut hole.”
Q. Will the government ration care?
No. But the specter of “rationing” is the battle cry of reform opponents. They say people in their 90s, 80s or even 70s will be deemed “too old” for joint replacements and cancer care—and even, in one persistent rumor, that “Obamacare” would deny treatment to people going blind in one eye as long as their other eye still works.
Where did this myth come from? It’s part of the “government takeover” argument, playing on often inaccurate beliefs that countries with national health systems severely ration care. In a widely circulated memo, political consultant Frank Luntz offered Republicans language that he believed would most resonate with Americans to defeat the Democrats’ push for reform. He suggested they say: “In countries with government run healthcare, politicians make your healthcare decisions. They decide if you’ll get the procedure you need … We can’t have that in America.”
What do the proposals say? In fact, they seek to prevent denial of care. Under every proposal, insurance companies would no longer be able to deny coverage on the basis of current health or preexisting medical conditions.
The proposals also would require plans to offer benefits packages with a comprehensive range of medical services equal to those in typical employer-sponsored plans. An independent advisory board, removed from political influence, would recommend new specific services to be covered based on scientific evidence. Annual or lifetime limits on coverage would be prohibited. None of the bills places any age limits on receiving medical care.
Where to go for the facts on health care reform proposals:
The following websites are run by nonpartisan organizations with no stake in the proposals:
The Kaiser Family Foundation's side-by-side comparison of the details of the leading proposals
The Annenberg Public Policy Center's fact checker
Politifact.com's Truth-O-Meter
By Patricia Barry:
Now it’s getting down and dirty. As expected, the gloves are off in President Obama’s push for health care reform. Democrats and Republicans are battling over how to fix a system they all agree is broken—that’s how Congress is supposed to work. But this summer something new has entered the political arena—a tsunami of rumors, myths, fear-mongering and misinformation about the proposals that surges around the Internet in nanoseconds. “I’m totally confused about what’s going on,” one reader wrote to the AARP Bulletin. “How do I know who to believe?”
Misinformation spreads at rapid speed
It’s a good question. Another is how this new phenomenon—the ability to spread misleading information at rapid speed through chain e-mails, blogs, text-messaging and “tweets”—will affect the reform debate.
“What we’re seeing is a flood of viral content that distorts the Obama effort to reform health care,” says Kathleen Hall Jamieson, director of the Annenberg Public Policy Center at the University of Pennsylvania, who codirects www.FactCheck.org, a website that examines questionable claims from all sides of the political spectrum.
Today’s opposition tools are very different from those used against previous attempts at health care reform in the Clinton era. Then, the key means of attack available were television advertising and direct-mail campaigns, which were expensive and took time to organize.
“Extremists and people who are so locked into their own ideology that they’ll distort anything have been out there forever,” Jamieson says. “But they haven’t had a way to reach out to as many people as efficiently as they have now.”
Understanding the proposals
Health care reform has “serious consequences to people’s lives, and it would be useful if as many people as possible actually understood what the proposals are about,” Jamieson says. But the rise of the Internet and the decline of the mainstream press as a prime source of information, she adds, put that prospect at risk.
To add to the confusion, Obama, while talking up his overall goals for reform, has left it to Congress to work out the details. The result: a number of committees, each developing and announcing scores of proposals, which change as negotiations progress. “This process has not been a success in garnering public support for reform, and has left people nervous,” says Robert Blendon, professor of health policy and political analysis at Harvard University’s School of Public Health. “So the headlines every day, because the bills are different, scare different people.”
Could the rumormongering affect the outcome? Recent angry exchanges and violent interruptions at lawmakers’ town hall meetings during the August recess suggest that it might. Members of Congress faced a barrage of questions based on the same Internet-spread myths.
If a disproportionate number of constituents who believe the rumors show up at meetings, while those who are happy with health reform stay home, what then? “Does that skew the member’s sense of public opinion?” Jamieson asks. “Does it send the member back [to Washington] saying, ‘I’m going to lose the election if I vote for this thing?’ ”
Blendon, though, thinks most voters, especially the independents, ultimately won’t be swayed by the myths. “The real debate for them is: What happens to me and my family out of this thing?” he says.
As proposals are refined into a single bill, which could happen this fall, Americans will get a better handle on what matters to them—whether their own health care costs would rise or fall under reform, whether taxes would increase to pay for it, and what impact it would have on the deficit, Blendon says.
Meanwhile, here are some of the persistent myths about health care reform, how they arose, and what the three leading current proposals—a House bill, a Senate health committee bill and a set of options still being considered by the Senate Finance Committee—actually say about those issues:
Q. Will the government take over health care so we end up with socialized medicine?
No. Neither the president nor the congressional committees have suggested anything remotely resembling a government takeover of health care.
Obama has specifically rejected the idea of a “single payer” system, like Canada’s, in which the government insures all citizens. None of the leading proposals in Congress even considers going down this road—a fact that has brought strong protests from some consumer and doctor groups that favor this approach. And although Sen. Edward Kennedy, D-Mass., has long called for a “Medicare for All” program, this is not included in proposals from the Senate health committee that he chairs.
Even further off the table is the concept of “socialized medicine”—in which the government not only runs health care but also owns hospitals and pays doctors’ salaries. Great Britain has this kind of setup, as do the Veterans Affairs and Department of Defense health programs in the United States.
Where did this myth come from? Opponents of reform constantly use the term “government-run health care” to disparage the reform proposals, despite the popularity and success of existing government-run programs like Medicare. The tactic often works. Even some Medicare beneficiaries say they’re worried about a “government takeover” of Medicare.
What do the proposals say? Obama has proposed setting up a single “public plan”—available only to those without employer insurance—to provide a voluntary alternative to the many private plans that offer individual health insurance. The House and Senate health committee bills propose a national public plan to compete with these plans and meet the same requirements. The Senate Finance Committee is expected to exclude a public plan. Lawmakers are also considering state-run community health co-ops as an option.
Q. Will private insurance be outlawed or wither on the vine?
No. Obama and the congressional committees say their objective is to build on the current system—keeping employer-sponsored group insurance and giving more consumer protections to people who are employed by small businesses or buy insurance as individuals.
Supporters of a public plan option argue that it would act as a safety net for the uninsured, provide competition for private insurers and, in Obama’s words, “keep them honest.” Opponents of the public option, including the health insurance industry, contend that it would ultimately destroy private insurance because the government could offer lower payment rates to doctors and hospitals, as Medicare now does.
Where did this myth come from? Currently 177 million people have employer or individual insurance. The issue caught fire after the Lewin Group, a research consulting firm owned by UnitedHealth Group, estimated that 119 million of them would switch to a public plan, if everybody were allowed to join it. But the proposals actually exclude those with employer insurance from the public plan. On that basis, the group estimates that 34.9 million would exit private insurance—but it was the high 119 million figure that ricocheted around the Internet.
Another public policy group, the Urban Institute, calculated that after reform, 161 million (or 91 percent) would still enroll in private plans. A third group, the Economic Policy Institute, examined how employers would react to a “pay or play” mandate, which would require them to either provide coverage or contribute up to 8 percent of payroll to cover the uninsured. Fears of a mass exodus from employer insurance “are overblown,” the study found. “Millions of workers will keep the employer-sponsored insurance they have today.”
What do the proposals say? Each of the proposals calls for national or regional heath insurance exchanges that would allow people without employer or public insurance and small employers to choose from a menu of private insurance plans (and a public option, if there is one), with online information to help compare them.
Subsidies would be available for people unable to afford the premiums, on a sliding scale according to income. And under the House bill, people with employer insurance would be eligible for government help if their premiums exceeded 11 percent of their income. Small businesses would also get subsidies.
People with existing insurance would be able to keep it after reform begins. But after that date, new individual policies could no longer be sold unless they met required standards of benefits. After five years, all plans—including group employer insurance—would have to meet those standards.
Q. Will the government encourage euthanasia to save costs?
No. This false but scary idea—now surging around the Internet in blogs and e-mails—claims that the House bill would require Medicare beneficiaries to have mandatory classes every five years to decide how to end their lives earlier. Typical e-mails add: “They’re going to push suicide to cut Medicare spending!” All identify page 425 of the bill as their source.
Where did this myth come from? On July 16, Betsy McCaughey, a former Republican lieutenant governor of New York, appeared on a conservative radio show. Citing page 425, she said: “Congress would make it mandatory … that every five years, people in Medicare have a required counseling session that will tell them how to end their life sooner … all to do what’s in society’s best interest.”
On July 23, Rep. John Boehner of Ohio, leader of the House Republicans, issued a statement saying: “This provision may start us down a treacherous path toward government-encouraged euthanasia if enacted into law.” On Aug. 7, former Alaska governor Sarah Palin described the proposal as setting up a “death panel.”
What does the proposal say? The clause on page 424 (section 1233) would require Medicare to pay doctors for their time if beneficiaries chose to consult them for information on advance care planning, such as making a living will, appointing a health proxy, and hospice care (already covered by Medicare). Medicare would pay for these sessions only once every five years.
AARP described McCaughey’s claims as “rife with gross—and even cruel—distortions” of legislation that “would not only help people make the best decisions for themselves [on end-of-life care], but also better ensure that their wishes are followed.”
Republican Sen. Johnny Isakson of Georgia, who has sponsored a bill that would also allow Medicare to cover end-of-life planning, characterized the death panel talk as “nuts.”
Q. Will Medicare be eliminated or gutted to pay for reform?
No. It’s inconceivable that any lawmaker would commit political suicide by proposing to get rid of Medicare. But the rumor has fast gained ground.
Where did this myth come from? Dick Morris, a political commentator, posted an article on his blog that began: “Obama’s health care proposal is, in effect, the repeal of the Medicare program as we know it.” Morris claimed that the proposals “will totally gut Medicare and replace it with government-managed care and rationing.” His article was picked up within days on some 281,000 websites.
What do the proposals say? It’s true they all seek to save billions from Medicare costs—not by cutting benefits, but by setting up new ways to pay doctors more fairly and to reward providers for quality of care instead of (as now) paying them a fee for each separate service; reducing waste and fraud; and reducing preventable hospital readmissions.
All the proposals would cut the amount of subsidies now paid to Medicare Advantage private health plans, which cost an average of 14 percent more per person than traditional Medicare does. Without subsidies, the private plans could become more efficient, or they could raise premiums, reduce benefits or withdraw from Medicare.
The proposals also add benefits to Medicare—such as covering more preventive services and narrowing the Part D “doughnut hole.”
Q. Will the government ration care?
No. But the specter of “rationing” is the battle cry of reform opponents. They say people in their 90s, 80s or even 70s will be deemed “too old” for joint replacements and cancer care—and even, in one persistent rumor, that “Obamacare” would deny treatment to people going blind in one eye as long as their other eye still works.
Where did this myth come from? It’s part of the “government takeover” argument, playing on often inaccurate beliefs that countries with national health systems severely ration care. In a widely circulated memo, political consultant Frank Luntz offered Republicans language that he believed would most resonate with Americans to defeat the Democrats’ push for reform. He suggested they say: “In countries with government run healthcare, politicians make your healthcare decisions. They decide if you’ll get the procedure you need … We can’t have that in America.”
What do the proposals say? In fact, they seek to prevent denial of care. Under every proposal, insurance companies would no longer be able to deny coverage on the basis of current health or preexisting medical conditions.
The proposals also would require plans to offer benefits packages with a comprehensive range of medical services equal to those in typical employer-sponsored plans. An independent advisory board, removed from political influence, would recommend new specific services to be covered based on scientific evidence. Annual or lifetime limits on coverage would be prohibited. None of the bills places any age limits on receiving medical care.
Where to go for the facts on health care reform proposals:
The following websites are run by nonpartisan organizations with no stake in the proposals:
The Kaiser Family Foundation's side-by-side comparison of the details of the leading proposals
The Annenberg Public Policy Center's fact checker
Politifact.com's Truth-O-Meter
Six health insurance executives could provide health care for 30,000 families
THE FOLLOWING SIX EXECUTIVE COMPENSATION PACKAGES COULD PROVIDE HEALTH CARE FOR 30,000 AMERICAN FAMILIES. I AM NOT OPPOSED TO PEOPLE MAKING VERY GOOD LIVINGS. I AM OPPOSED TO MAKING A VERY GOOD LIVING BY DEPRIVING LESS FORTUNATE PEOPLE HEALTH CARE. THESE COMPENSATION PACKAGES ARE FUNDED BY DENYING TREATMENT, DELAYING TREATMENT, AND IN MANY CASES TERMINATING HEALTH INSURANCE WHEN A CLAIM IS MADE AFTER YEARS OF PAYING PREMIUMS. FOR ADDITIONAL INFORMATION visit http://sickforprofit.com/
UnitedHealth CEO
Stephen J. Hemsley
2007 Compensation
$13.2 million
2008 Compensation (Forbes)
$3,241,042
Former Managing Partner and CFO of Arthur Andersen (BusinessWeek)
Total Value of Unexercised Stock Options (Forbes)
$744,232,068
2009 Options Exercise
$127,001,281
Value of Wayzata, Minnesota Home (Hennepin County Assessor)
$6,640,000
Articles:
Hemsley returns $190 million in stock options acquired as a result of practices found to be fraudulent by the SEC (American Medical News)
CIGNA CEO
Edward Hanway
Five-Year Compensation, as of April 30, 2008 (Forbes)
$120.51 million
Total Value of Unexercised Stock Options (Forbes)
$28,881,000
Value of New Jersey Beach Home (Cape May County Assessor)
$13,607,400
Articles:
The family of a 17-year-old girl who died hours after CIGNA reversed a decision and said it would pay for a liver transplant plans to sue the company, their attorney said Friday. (Oakland Tribune)
Hundreds of entertainment industry workers in California and New Jersey who buy health insurance as a group are being hit with a rate increase that will raise some family-plan premiums to more than $44,000 a year. (USA Today)
Humana CEO
Michael McCallister
2007 Compensation
$10.3 million
2008 Compensation (Forbes)
$1,017,308
Five-Year Compensation Total (Forbes)
$15.1 million
Total Value of Unexercised Stock Options (Forbes)
$60,865,194
2006 Options Exercise (SECForm4)
$22,294,710
Value of Park City, Utah Home (County Assessor)
$6,978,380
Articles:
Humana abandons senior citizens in Florida, returns after Republicans pass new Medicare law, upping HMO payments by ~ 25% (NY Times)
Aetna CEO
Ronald A. Williams
2007 Compensation
$23 million
2008 Compensation (Forbes)
$24,300,112
Total Value of Unexercised Options (Forbes)
$194,496,797
Williams is in the top ten of Forbes'"$100 Million CEO Club."
Articles:
Health insurance giants Aetna and CIGNA, along with others, became the latest targets of a wide-ranging probe launched by New York Attorney General Eliot Spitzer, according to USA Today. (USA Today)
Coventry CEO
Allen Wise
CEO from 1996-2004, and from January 2009-Present
2004 Compensation (Forbes)
$13,052,799
2006 Sale of Stock
$14,458,251
2006 Options Exercised
$2,895,000
2005 Sale of Stock
$46,410,695
2005 Options Exercised
$6,709,564
2004 Sale of Stock
$12,826,756
2004 Options Exercised
$4,798,000
Value of Hilton Head, SC Home (Beaufort County Assessor)
$3,275,500
WellPoint CEO
Angela Braly
2007 Compensation (secinfo)
$9,094,271
2008 Compensation (Forbes)
$9,844,212
2006 Sale of Stock (SECForm4)
$4,858,585
2006 Options Excerise (SECForm4)
$4,566,124
Value of Indianapolis Home
$1,987,700
UnitedHealth CEO
Stephen J. Hemsley
2007 Compensation
$13.2 million
2008 Compensation (Forbes)
$3,241,042
Former Managing Partner and CFO of Arthur Andersen (BusinessWeek)
Total Value of Unexercised Stock Options (Forbes)
$744,232,068
2009 Options Exercise
$127,001,281
Value of Wayzata, Minnesota Home (Hennepin County Assessor)
$6,640,000
Articles:
Hemsley returns $190 million in stock options acquired as a result of practices found to be fraudulent by the SEC (American Medical News)
CIGNA CEO
Edward Hanway
Five-Year Compensation, as of April 30, 2008 (Forbes)
$120.51 million
Total Value of Unexercised Stock Options (Forbes)
$28,881,000
Value of New Jersey Beach Home (Cape May County Assessor)
$13,607,400
Articles:
The family of a 17-year-old girl who died hours after CIGNA reversed a decision and said it would pay for a liver transplant plans to sue the company, their attorney said Friday. (Oakland Tribune)
Hundreds of entertainment industry workers in California and New Jersey who buy health insurance as a group are being hit with a rate increase that will raise some family-plan premiums to more than $44,000 a year. (USA Today)
Humana CEO
Michael McCallister
2007 Compensation
$10.3 million
2008 Compensation (Forbes)
$1,017,308
Five-Year Compensation Total (Forbes)
$15.1 million
Total Value of Unexercised Stock Options (Forbes)
$60,865,194
2006 Options Exercise (SECForm4)
$22,294,710
Value of Park City, Utah Home (County Assessor)
$6,978,380
Articles:
Humana abandons senior citizens in Florida, returns after Republicans pass new Medicare law, upping HMO payments by ~ 25% (NY Times)
Aetna CEO
Ronald A. Williams
2007 Compensation
$23 million
2008 Compensation (Forbes)
$24,300,112
Total Value of Unexercised Options (Forbes)
$194,496,797
Williams is in the top ten of Forbes'"$100 Million CEO Club."
Articles:
Health insurance giants Aetna and CIGNA, along with others, became the latest targets of a wide-ranging probe launched by New York Attorney General Eliot Spitzer, according to USA Today. (USA Today)
Coventry CEO
Allen Wise
CEO from 1996-2004, and from January 2009-Present
2004 Compensation (Forbes)
$13,052,799
2006 Sale of Stock
$14,458,251
2006 Options Exercised
$2,895,000
2005 Sale of Stock
$46,410,695
2005 Options Exercised
$6,709,564
2004 Sale of Stock
$12,826,756
2004 Options Exercised
$4,798,000
Value of Hilton Head, SC Home (Beaufort County Assessor)
$3,275,500
WellPoint CEO
Angela Braly
2007 Compensation (secinfo)
$9,094,271
2008 Compensation (Forbes)
$9,844,212
2006 Sale of Stock (SECForm4)
$4,858,585
2006 Options Excerise (SECForm4)
$4,566,124
Value of Indianapolis Home
$1,987,700
Tuesday, September 8, 2009
Health Care NOW: Historical or Hysterical?
MEDSCAPE Article on Health Care Refor Debate
August 31, 2009 — The healthcare-reform debate boggles the mind, whether it's the trillions of dollars at stake, the thousands of pages of legislation cranked out by Congress, or the superheated rhetoric in townhall meetings. How did the subject of insurance coverage for all morph into euthanasia?
Then again, with healthcare amounting to a cradle-to-grave issue for every individual and accounting for almost 18% of the economy, it is not surprising the current debate has taken on historic, if not hysterical, proportions.
The role played by physicians, too, is historic. Organized medicine has traditionally opposed government intervention in healthcare, but the first full-blown piece of reform legislation to emerge — HR 3200 in the House — has won the support, albeit qualified, of the American Medical Association (AMA), the American College of Physicians (APC), the American Academy of Family Physicians (AAFP), the American College of Surgeons (ACS), the American Osteopathic Association, the American College of Obstetricians and Gynecologists, and other medical organizations.
Contrary to what many of their constituents believe, these organizations assert that the proposal to extend coverage to the uninsured, partly through a controversial government-run plan, and to more tightly regulate private insurers doesn't represent the bogeyman of socialized medicine. They also argue that the bill benefits physicians, primarily by scrapping the Sustainable Growth Rate (SGR) formula for setting Medicare pay and averting a 21.5% across-the-board cut next January.
"If you come to 2010 without fixing the SGR, this would have a catastrophic affect on primary care and other specialties," said ACP president Joseph Stubbs, MD, from Albany, Georgia.
HR 3200, the product of 3 House committees, is only a rough draft of reform for Congress, which reconvenes in September after summer recess. The House committees will continue refining HR 3200 while Senate committees craft their own bills; these will eventually be merged.
The House and Senate will then vote on their respective unified bills, which, if approved, would need to be reconciled so an identical bill would go to each legislative body for a final vote. Although HR 3200 might not exactly resemble the end product, it nevertheless provides a good look at the bullet points of the healthcare-reform debate of 2009.
All But 3% of Legal Residents Would Have Coverage
The centerpiece of HR 3200, dubbed America's Affordable Health Choices Act, is the Health Insurance Exchange. It is a marketplace in which individuals, families, and small businesses with annual payrolls not exceeding $250,000 will be able to shop for insurance plans, and which will include a "public option" operated by the government (this plan might be taken off the drawing board, though — more on that later).
Cash-strapped individuals and families would receive "affordability credits" on the basis of income, and small businesses would receive tax credits toward purchasing coverage. In contrast, larger businesses are obliged to "play or pay" — either provide coverage for employees or pay into a fund to finance coverage through the exchange.
All individuals are required to obtain coverage through their employer or the exchange, or they will have to pay a penalty. If they already have coverage through an employer or an individual policy, they can keep it, although grandfathered employer-sponsored plans must satisfy the bill's requirements by 2018. Meanwhile, the bill would expand Medicaid eligibility, bringing 11 million more people into the program by 2019, according to the Congressional Budget Office (CBO).
HR 3200 also rewrites the terms of insurance coverage, authorizing a minimum menu of benefits — including preventive services with no cost sharing — that will be a template for all plans offered through the exchange and, eventually, those available from large employers. Health insurers would be prohibited from denying coverage on the basis of an individual's preexisting conditions or dropping coverage for sick individuals (except if they have perpetrated a fraud). Furthermore, they could charge premiums only on the basis of age, geography, and family size — not health status or sex.
The CBO estimates that the bill would reduce the number of uninsured from a projected 51 million in 2010 to 17 million in 2019, 9 million of whom would be illegal immigrants who wouldn't be eligible for premium subsidies. In effect, 97% of legal residents would become insured.
Competition Enhancer or Killer?
The public-option plan is designed to give individuals and small businesses an alternative to private insurers, especially in markets where 1 or 2 companies dominate.
"It would be nice to see some competition," said William Jessee, MD, president and CEO of the Medical Group Management Association, which has not taken a position on HR 3200. "Membership satisfaction with Medicare is very high, so the idea of having another government-operated program doesn't frighten me. It would push private insurers to pay more accurately and promptly."
However, other physicians, such as former AMA president and general and vascular surgeon Donald Palmisano, MD, view the public option as the Trojan horse that would usher in a government-run single-payer system by unfairly squeezing out private insurers. "Having the government for a competitor is like playing against a football team that's doubling as the referee," said Dr. Palmisano, a spokesperson for a group called the Coalition to Protect Patient Rights. "It will move the goal posts when you're ready to kick a field goal."
Such fears strike Stanford University economist Alain Enthoven, PhD, as realistic. By paying providers based on the Medicare rates, the public-option plan would enjoy a cost advantage over private insurers and their higher rates, said Dr. Enthoven, who authored the concept of "managed competition" that figured into the failed healthcare-reform proposal of the Clinton administration. And although HR 3200 stipulates that the public option is to be financed strictly through premiums, Dr. Enthoven expects that Congress would eventually allocate tax dollars.
"It strains credulity to suggest that the public plan wouldn't be unfairly subsidized," Dr. Enthoven said, noting that "some of the enthusiasts for the public option admit offline that its purpose is to drive private insurers out of business."
Various groups have attempted to precisely calculate the impact of a public plan on private insurance. The CBO projects that the number of privately insured Americans would increase 9% through 2019, to 161 million, under HR 3200, even as enrollment in the public plan reaches 11 to 12 million.
The nonpartisan Urban Institute forecasts a 9% drop in the number of privately insured during this time if a public plan materializes. Perhaps the most negative assessment comes from the Lewin Group, a consulting firm owned by health insurer UnitedHealth Group. It predicts that the public plan under HR 3200 would cover 34 million Americans by 2019, while the number of privately insured would decrease 20%, to 138 million, if eligibility for the public plan is limited to small firms. If it is extended to larger employers — something the bill permits — public-plan enrollment would grow to 103 million while private-plan enrollment would shrink 48%, to 89 million.
With the public plan drawing flak, President Obama and lawmakers have suggested that they might replace this component of healthcare reform with regional or state-wide health-insurance cooperatives, akin to those in rural America that provide electricity or water. A few such cooperatives already exist in healthcare — witness the Seattle-based Group Health Cooperative — but expert opinion is mixed as to whether these member-owned organizations would be large enough to negotiate favorable rates with hospitals and physicians and compete effectively with private insurers.
What HR 3200 Does for Medicine
A healthcare system with more insured patients will need more primary-care physicians to treat them, and HR 3200 attempts to put more in the pipeline. Among other things, the legislation boosts funding for the National Health Services Corps, which finances a doctor's medical training in exchange for working in underserved areas, and creates other grant and loan programs for primary-care trainees.
The bill also tries to improve physician compensation, especially for primary-care doctors. The legislation eliminates that the much-maligned SGR formula for Medicare would have subjected physicians to an overall 21.5% cut in 2010.
Pegged to changes in the gross domestic product (GDP), the SGR sets a target for Medicare expenditures on physician services each year, and if actual expenditures exceed the target, physicians face a corresponding pay cut the following year.
Physicians complain that the SGR underestimates healthcare inflation and the way it affects their own costs. Since 2002, spending on physician services has regularly overshot the targets, triggering cuts. And year after year, Congress has cancelled scheduled reductions in response to physician outcry, but the SGR "debt" continues to accumulate, topping $300 billion as of last December, according to the CBO. This mounting debt makes future reductions even deeper.
In a single stroke, HR 3200 would eliminate the scheduled cut for 2010 by erasing the accumulated SGR debt from the books. Instead, Medicare would raise its rates next year based on its estimate of inflation in physician-practice costs. By averting a compensation train wreck in Medicare, the bill also would forestall reductions by private insurers, noted Dallas general surgeon John Preskitt, MD, who sits on the ACS Board of Regents. "Some plans base their rates on Medicare's."
Gradual Rise in Woefully Low Medicaid Fees
Beginning in 2011, a new formula kicks in, creating 2 separate spending targets for physician services under Medicare. One target is based on GDP plus 2% or evaluation and management services and preventive care — a nod to cognitive-oriented primary-care doctors — and the other on GDP plus 1% for all other physician services.
This break for primary care in the revamped formula is just 1 way in which HR 3200 attempts to attract more trainees to this field and avert a workforce shortage. The bill boosts Medicare rates for primary-care physicians by an additional 5% — 10% for those in medically underserved areas. And the woefully low fees they receive from Medicaid would gradually be raised to Medicare levels.
In addition, the government would spend more money to experiment with new ways to deliver care — such as patient-centered medical homes and accountable care organizations — that would reimburse physicians on the basis of quality and cost-effectiveness, concepts foreign to the fee-for-service model.
A number of leaders in organized medicine view such "pay-for-performance" arrangements as the ultimate cure for the Medicare pay problem, relieving doctors of the need to perform more and more services to make up for shrinking reimbursement.
"We're looking for a value-based system, not a volume-based system," said Philadelphia cardiologist Alfred Bove, MD, president of the American College of Cardiology.
Is Healthcare Reform Affordable?
With the federal deficit projected to hit $1.6 trillion in 2009, and anywhere from $7 trillion to $9 trillion through 2019, proposals to overhaul the healthcare system must convince budget hawks that they pass the affordability test. The CBO estimates that HR 3200 will add $239 billion to the deficit through 2019 after new revenues and cost savings in Medicaid and Medicare are subtracted from outlays.
Significantly, CBO director Douglas Elmendorf told Congress that he saw nothing in the bill that would fundamentally bend the cost of healthcare downward. Likewise, a competing healthcare-reform bill from the Senate Committee on Health, Education, Labor, and Pensions would produce roughly $1 trillion in red ink during that period, according to the CBO.
To Dr. Joseph Stubbs of the ACP, HR 3200 essentially pays for itself, as opposed to increasing the federal deficit, if one subtracts the cost of retiring the accumulated SGR debt in Medicare — a position taken by some House Democrats.
In addition, Dr. Stubbs said the CBO did not factor in potential cost savings from new healthcare-delivery models, such as the medical home, which could save $175 billion over 10 years through improved coordination of care.
Myths Abound
Critics of HR 3200 have raised a blizzard of objections, some fact-based and some far-fetched. Take the assertion, for example, that the bill authorizes bureaucratic "death panels" that will ration care and promote euthanasia. It arose from a provision on reimbursing physicians for counseling patients about hospices, palliative care, and other end-of-life issues — a provision applauded by none other than the gray-haired American Association of Retired Persons.
"People who receive this kind of counseling feel better about the choices they make," said Dr. Stubbs, adding that "it's all voluntary."
Groups including the ACP and the AAFP recently issued a joint statement rebutting the "death panel" myth, along with several dozen others, among them the notions that free healthcare would be extended to illegal aliens, that the government would gain access to all financial and personal records of citizens, and that the bill would subsidize abortions.
"It's a sad commentary that the public debate has become fueled by misinformation," said Dr. Jessee of the Medical Group Management Association. "Some of it is innocent; some of it is intentional, I think. It's also a commentary on how complex the issue is and how much our citizenry would like to have a simple solution."
Journalist
Robert Lowes
is a freelance writer for Medscape.
August 31, 2009 — The healthcare-reform debate boggles the mind, whether it's the trillions of dollars at stake, the thousands of pages of legislation cranked out by Congress, or the superheated rhetoric in townhall meetings. How did the subject of insurance coverage for all morph into euthanasia?
Then again, with healthcare amounting to a cradle-to-grave issue for every individual and accounting for almost 18% of the economy, it is not surprising the current debate has taken on historic, if not hysterical, proportions.
The role played by physicians, too, is historic. Organized medicine has traditionally opposed government intervention in healthcare, but the first full-blown piece of reform legislation to emerge — HR 3200 in the House — has won the support, albeit qualified, of the American Medical Association (AMA), the American College of Physicians (APC), the American Academy of Family Physicians (AAFP), the American College of Surgeons (ACS), the American Osteopathic Association, the American College of Obstetricians and Gynecologists, and other medical organizations.
Contrary to what many of their constituents believe, these organizations assert that the proposal to extend coverage to the uninsured, partly through a controversial government-run plan, and to more tightly regulate private insurers doesn't represent the bogeyman of socialized medicine. They also argue that the bill benefits physicians, primarily by scrapping the Sustainable Growth Rate (SGR) formula for setting Medicare pay and averting a 21.5% across-the-board cut next January.
"If you come to 2010 without fixing the SGR, this would have a catastrophic affect on primary care and other specialties," said ACP president Joseph Stubbs, MD, from Albany, Georgia.
HR 3200, the product of 3 House committees, is only a rough draft of reform for Congress, which reconvenes in September after summer recess. The House committees will continue refining HR 3200 while Senate committees craft their own bills; these will eventually be merged.
The House and Senate will then vote on their respective unified bills, which, if approved, would need to be reconciled so an identical bill would go to each legislative body for a final vote. Although HR 3200 might not exactly resemble the end product, it nevertheless provides a good look at the bullet points of the healthcare-reform debate of 2009.
All But 3% of Legal Residents Would Have Coverage
The centerpiece of HR 3200, dubbed America's Affordable Health Choices Act, is the Health Insurance Exchange. It is a marketplace in which individuals, families, and small businesses with annual payrolls not exceeding $250,000 will be able to shop for insurance plans, and which will include a "public option" operated by the government (this plan might be taken off the drawing board, though — more on that later).
Cash-strapped individuals and families would receive "affordability credits" on the basis of income, and small businesses would receive tax credits toward purchasing coverage. In contrast, larger businesses are obliged to "play or pay" — either provide coverage for employees or pay into a fund to finance coverage through the exchange.
All individuals are required to obtain coverage through their employer or the exchange, or they will have to pay a penalty. If they already have coverage through an employer or an individual policy, they can keep it, although grandfathered employer-sponsored plans must satisfy the bill's requirements by 2018. Meanwhile, the bill would expand Medicaid eligibility, bringing 11 million more people into the program by 2019, according to the Congressional Budget Office (CBO).
HR 3200 also rewrites the terms of insurance coverage, authorizing a minimum menu of benefits — including preventive services with no cost sharing — that will be a template for all plans offered through the exchange and, eventually, those available from large employers. Health insurers would be prohibited from denying coverage on the basis of an individual's preexisting conditions or dropping coverage for sick individuals (except if they have perpetrated a fraud). Furthermore, they could charge premiums only on the basis of age, geography, and family size — not health status or sex.
The CBO estimates that the bill would reduce the number of uninsured from a projected 51 million in 2010 to 17 million in 2019, 9 million of whom would be illegal immigrants who wouldn't be eligible for premium subsidies. In effect, 97% of legal residents would become insured.
Competition Enhancer or Killer?
The public-option plan is designed to give individuals and small businesses an alternative to private insurers, especially in markets where 1 or 2 companies dominate.
"It would be nice to see some competition," said William Jessee, MD, president and CEO of the Medical Group Management Association, which has not taken a position on HR 3200. "Membership satisfaction with Medicare is very high, so the idea of having another government-operated program doesn't frighten me. It would push private insurers to pay more accurately and promptly."
However, other physicians, such as former AMA president and general and vascular surgeon Donald Palmisano, MD, view the public option as the Trojan horse that would usher in a government-run single-payer system by unfairly squeezing out private insurers. "Having the government for a competitor is like playing against a football team that's doubling as the referee," said Dr. Palmisano, a spokesperson for a group called the Coalition to Protect Patient Rights. "It will move the goal posts when you're ready to kick a field goal."
Such fears strike Stanford University economist Alain Enthoven, PhD, as realistic. By paying providers based on the Medicare rates, the public-option plan would enjoy a cost advantage over private insurers and their higher rates, said Dr. Enthoven, who authored the concept of "managed competition" that figured into the failed healthcare-reform proposal of the Clinton administration. And although HR 3200 stipulates that the public option is to be financed strictly through premiums, Dr. Enthoven expects that Congress would eventually allocate tax dollars.
"It strains credulity to suggest that the public plan wouldn't be unfairly subsidized," Dr. Enthoven said, noting that "some of the enthusiasts for the public option admit offline that its purpose is to drive private insurers out of business."
Various groups have attempted to precisely calculate the impact of a public plan on private insurance. The CBO projects that the number of privately insured Americans would increase 9% through 2019, to 161 million, under HR 3200, even as enrollment in the public plan reaches 11 to 12 million.
The nonpartisan Urban Institute forecasts a 9% drop in the number of privately insured during this time if a public plan materializes. Perhaps the most negative assessment comes from the Lewin Group, a consulting firm owned by health insurer UnitedHealth Group. It predicts that the public plan under HR 3200 would cover 34 million Americans by 2019, while the number of privately insured would decrease 20%, to 138 million, if eligibility for the public plan is limited to small firms. If it is extended to larger employers — something the bill permits — public-plan enrollment would grow to 103 million while private-plan enrollment would shrink 48%, to 89 million.
With the public plan drawing flak, President Obama and lawmakers have suggested that they might replace this component of healthcare reform with regional or state-wide health-insurance cooperatives, akin to those in rural America that provide electricity or water. A few such cooperatives already exist in healthcare — witness the Seattle-based Group Health Cooperative — but expert opinion is mixed as to whether these member-owned organizations would be large enough to negotiate favorable rates with hospitals and physicians and compete effectively with private insurers.
What HR 3200 Does for Medicine
A healthcare system with more insured patients will need more primary-care physicians to treat them, and HR 3200 attempts to put more in the pipeline. Among other things, the legislation boosts funding for the National Health Services Corps, which finances a doctor's medical training in exchange for working in underserved areas, and creates other grant and loan programs for primary-care trainees.
The bill also tries to improve physician compensation, especially for primary-care doctors. The legislation eliminates that the much-maligned SGR formula for Medicare would have subjected physicians to an overall 21.5% cut in 2010.
Pegged to changes in the gross domestic product (GDP), the SGR sets a target for Medicare expenditures on physician services each year, and if actual expenditures exceed the target, physicians face a corresponding pay cut the following year.
Physicians complain that the SGR underestimates healthcare inflation and the way it affects their own costs. Since 2002, spending on physician services has regularly overshot the targets, triggering cuts. And year after year, Congress has cancelled scheduled reductions in response to physician outcry, but the SGR "debt" continues to accumulate, topping $300 billion as of last December, according to the CBO. This mounting debt makes future reductions even deeper.
In a single stroke, HR 3200 would eliminate the scheduled cut for 2010 by erasing the accumulated SGR debt from the books. Instead, Medicare would raise its rates next year based on its estimate of inflation in physician-practice costs. By averting a compensation train wreck in Medicare, the bill also would forestall reductions by private insurers, noted Dallas general surgeon John Preskitt, MD, who sits on the ACS Board of Regents. "Some plans base their rates on Medicare's."
Gradual Rise in Woefully Low Medicaid Fees
Beginning in 2011, a new formula kicks in, creating 2 separate spending targets for physician services under Medicare. One target is based on GDP plus 2% or evaluation and management services and preventive care — a nod to cognitive-oriented primary-care doctors — and the other on GDP plus 1% for all other physician services.
This break for primary care in the revamped formula is just 1 way in which HR 3200 attempts to attract more trainees to this field and avert a workforce shortage. The bill boosts Medicare rates for primary-care physicians by an additional 5% — 10% for those in medically underserved areas. And the woefully low fees they receive from Medicaid would gradually be raised to Medicare levels.
In addition, the government would spend more money to experiment with new ways to deliver care — such as patient-centered medical homes and accountable care organizations — that would reimburse physicians on the basis of quality and cost-effectiveness, concepts foreign to the fee-for-service model.
A number of leaders in organized medicine view such "pay-for-performance" arrangements as the ultimate cure for the Medicare pay problem, relieving doctors of the need to perform more and more services to make up for shrinking reimbursement.
"We're looking for a value-based system, not a volume-based system," said Philadelphia cardiologist Alfred Bove, MD, president of the American College of Cardiology.
Is Healthcare Reform Affordable?
With the federal deficit projected to hit $1.6 trillion in 2009, and anywhere from $7 trillion to $9 trillion through 2019, proposals to overhaul the healthcare system must convince budget hawks that they pass the affordability test. The CBO estimates that HR 3200 will add $239 billion to the deficit through 2019 after new revenues and cost savings in Medicaid and Medicare are subtracted from outlays.
Significantly, CBO director Douglas Elmendorf told Congress that he saw nothing in the bill that would fundamentally bend the cost of healthcare downward. Likewise, a competing healthcare-reform bill from the Senate Committee on Health, Education, Labor, and Pensions would produce roughly $1 trillion in red ink during that period, according to the CBO.
To Dr. Joseph Stubbs of the ACP, HR 3200 essentially pays for itself, as opposed to increasing the federal deficit, if one subtracts the cost of retiring the accumulated SGR debt in Medicare — a position taken by some House Democrats.
In addition, Dr. Stubbs said the CBO did not factor in potential cost savings from new healthcare-delivery models, such as the medical home, which could save $175 billion over 10 years through improved coordination of care.
Myths Abound
Critics of HR 3200 have raised a blizzard of objections, some fact-based and some far-fetched. Take the assertion, for example, that the bill authorizes bureaucratic "death panels" that will ration care and promote euthanasia. It arose from a provision on reimbursing physicians for counseling patients about hospices, palliative care, and other end-of-life issues — a provision applauded by none other than the gray-haired American Association of Retired Persons.
"People who receive this kind of counseling feel better about the choices they make," said Dr. Stubbs, adding that "it's all voluntary."
Groups including the ACP and the AAFP recently issued a joint statement rebutting the "death panel" myth, along with several dozen others, among them the notions that free healthcare would be extended to illegal aliens, that the government would gain access to all financial and personal records of citizens, and that the bill would subsidize abortions.
"It's a sad commentary that the public debate has become fueled by misinformation," said Dr. Jessee of the Medical Group Management Association. "Some of it is innocent; some of it is intentional, I think. It's also a commentary on how complex the issue is and how much our citizenry would like to have a simple solution."
Journalist
Robert Lowes
is a freelance writer for Medscape.
$400,000,000 Spent on Influencing Health Care NOW
Health care lobbying: Political power machineLobbying. TV ads. Political donations. Nearly $400 million has already been spent to influence the debate - the most expensive fight ever to hit Congress.By Jennifer Liberto, CNNMoney.com senior writerWASHINGTON (CNNMoney.com) -- The fight over health care overhaul is on track to be the most expensive issue ever to hit the hallways of Congress.The bill for lobbyists, television ads and political donations has topped $375 million -- or enough to pay the entire insurance tab for about 30,000 families a year.The big spenders range from drug companies, hospitals and doctor groups to organizations that advocate for unions, immigrants and retirees.The largest chunk has gone to direct lobbying of lawmakers and other policymakers. In the first half of 2009, the health care industry spent nearly $280 million on lobbyists, according to the Center for Responsive Politics.Another $75 million was spent on television advertising airtime by health care interests, mostly politically left-leaning groups and health industries. And another $23 million has flowed from the health care sector into the campaign war chests of 2010 candidates for federal office, on the heels of some $95 million raised during the 2008 cycle."The health sector is on track in 2009 to spend more on lobbying than it has on any other year in U.S. history -- and by a lot," said Dave Levinthal of the Center for Responsive Politics, which analyzes and collects lobbying and campaign spending figures.
Congressman Thompson Responds to Fear and Ignorance
Following is a letter from Northern California Congressman MikeThompson in response to his constituents expressions of concerns and misinformation regarding Health Care REFORM. The name of the person receiving this letter was removed for privacy. The content of the letter is very informative and helps set the record straight.
Dear Constituent:
I have a keen interest in healthcare, both as an individual and as a public servant. My wife Jan is a full-time nurse practitioner in our district and was a hospice nurse for years. I've had government sponsored healthcare in the Army - both here and overseas - and private healthcare with Kaiser Permanente and Blue Cross Blue Shield. Over the years, as a State Senator and U.S. Representative, I've talked with thousands of Northern Californians at length about the times when healthcare has been a blessing and, unfortunately, when it's failed them.
<>
I first ran for office in 1990, and a big part of that decision was because of the challenges of healthcare policy and its importance. This issue has remained in the forefront of my attention ever since. In the State Senate, I passed legislation that required all group healthcare plans to provide preventive healthcare to children, improved healthcare policies in rural areas and supported the development of telemedicine. Since arriving in the House of Representatives, I continued this work by enacting legislation that waives co-pays for colonoscopies and mammograms for Medicare beneficiaries, helps doctors who are called away to service in the reserves or the National Guard, expands telehealth technology, reverses harmful cuts to Medicare reimbursement rates for physicians, promotes funding for rural clinics and addresses unfair geographic reimbursement policies that consistently underpay providers in our district. <>
Unfortunately, many problems like rising premiums, shortages of skilled healthcare workers and a deteriorating long-term fiscal outlook for programs like Medicare have grown worse. These issues are far larger, more complex and more pervasive than almost any others our nation faces. It is no surprise that they have also drawn the most passionate responses. <>
Some argue that any type of reform would lead to socialism, but the majority of constituents I've heard from want Congress to lower costs, provide access for everyone and improve the quality of care. Most opinions are heartfelt, but a few are startling, such as the writers who want to reject any government involvement in healthcare because it's "socialist" while they themselves are receiving healthcare through Medicare or the Veterans Administration. However, almost every person I talk to or hear from agrees - the current healthcare system needs to be fixed. <>
While I am a strong proponent of healthcare reform, we need to make sure that we do this right. As you no doubt know, our current healthcare system is not sustainable. In the last 15 years, healthcare spending has jumped 145% to over $2.24 trillion. This is the equivalence of one in every $6 we earn going for healthcare. At current rates, within a decade that figure is expected to rise to one in $5, and within 30 years it will be one out of every $3. Right now, this system is failing us all; from those who can't get insurance because of a pre-existing condition to the families that have coverage but are finding it harder and harder to afford their rising premiums and deductibles. We are on an unsustainable path and most Americans want this corrected.
The House of Representatives is now considering the America's Affordable Health Choices Act (H.R. 3200), which presents comprehensive solutions to the healthcare challenges faced by all Americans. This bill includes many of my priorities, such as:
o Better healthcare for everyone by requiring all plans to meet minimum benefits standards, prohibiting denials of coverage based on pre-existing conditions and eliminating co-payments for preventive care visits to a doctor;
o Strengthening Medicare by increasing reimbursement rates for Medicare providers to allow them to continue seeing Medicare patients and closing the "donut" hole in prescription coverage for Medicare Part D;
o Real choice in a health insurance marketplace where consumers can compare different plans, including a public plan option, while still retaining the freedom to keep their current doctor, hospital and plan if they choose;
o Ensuring access to healthcare in rural areas by providing a reimbursement increase to primary care physicians practicing in these communities and expanding telemedicine services to make specialized care available for patients in underserved areas.
As a member of the Ways and Means Committee, I helped write parts of this bill, and I know that there is a lot in the bill that will go far toward improving our system. Although the full House of Representatives will not consider H.R. 3200 until September, I voted for this important legislation when it was considered by the Ways and Means Committee on July 17. We needed to advance this bill so that we can continue the work of crafting a comprehensive plan that will fix our healthcare system.
<> However, it is important to remember that this is the beginning of the process, and there is much work that remains to be done in both houses of Congress before we will reach a final bill. Nevertheless, there is wide agreement that the final version must satisfy these principles:
o Reduce the long-term growth of healthcare costs;
o Provide a choice of doctors and health plans;
o Improve quality of care and invest in prevention and wellness; and,
o Ensure affordable healthcare for all Americans.
Currently there are five bills in Congress to reform healthcare, three in the House and two in the Senate. From these, members of the House and Senate will reconcile differences, make improvements and come up with an even better bill. I think we have a long way to go before we are where we need to be, but H.R. 3200 is an important first step.
<> Healthcare touches all of our lives in a very personal way. I absolutely understand why so many Americans are concerned about the effectiveness and cost of healthcare. That's why it's so important that you judge the facts of this bill for yourself, particularly when there's been much disinformation. I have attached answers to the most common questions my office has been receiving for your review. Additionally, you can go to the Ways and Means Committee website (waysandmeans.house.gov) to read the bill in its entirety as well as a section-by-section summary. I will continue to update you as this important legislation progresses.
Question: Has Congressman Thompson read the bill?
Answer: I have read and was involved in drafting the bill I voted on. For weeks before the introduction of H.R. 3200, members of the Ways and Means Committee, myself included, met daily to go through the bill line by line and section by section. As a group, we spent 86 hours going over this legislation.
Question: Will health reform force all Americans out of their private insurance plans and into a one-size-fits-all government plan?
Answer: No. H.R. 3200 builds on the current system of employer-based coverage, it doesn't replace it. If you are happy with your current plan, you can keep it. H.R. 3200 includes a public plan that individuals will have the option of purchasing, along with a variety of other private plans. This public plan will be required to be financially self-sustaining, as private plans are, covering its costs through premiums and co-pays.
Question: Does page 16 of the bill require me to join the public plan if I lose my private insurance coverage?
Answer: No one will be required to join the public plan. If you lose your insurance, you will be able to shop for a new plan at an online exchange that includes information on all insurance options. This exchange will bring together information that is currently scattered giving consumers the opportunity to quickly and effectively compare plans to make informed decisions about what coverage works best for them. The provision on page 16 merely requires individuals joining a private insurance plan after 2013 to do so through the exchange.
Question: Are Members of Congress exempt from changes that are being proposed for the rest of the country?
Answer: No. Members of Congress receive the same healthcare options as other federal employees, with a choice of plans from private insurers that vary by benefits, premiums and co-pays. This legislation would affect federal employees in the same ways that it affects everyone else who gets their health insurance through their employer.
Question: Does this bill cover illegal immigrants?
Answer: No. Section 246 of H.R. 3200 explicitly prohibits the payment of affordability credits designed to help low and moderate incomes families purchase insurance to anyone who is not lawfully present in the United States.
Question: Does this bill require seniors to attend mandatory counseling sessions on euthanasia?
Answer: No. H.R. 3200 states that Medicare will reimburse doctors and nurse practitioners for a counseling session with Medicare beneficiaries regarding advanced care planning. This consultation includes a discussion of laws and options regarding living wills, the roles and responsibilities of a health care proxy and other planning resources that may be available for the individual. These consultations are strictly voluntary.
Question: Will all small businesses be forced to provide coverage to their employees?
Answer: This bill exempts small businesses with a payroll of less than $250,000 from the requirement to provide health insurance for their workers. Businesses with payrolls above $250,000 that do not provide coverage will be assessed a charge that will gradually increase with the size of their payroll. The current version of the bill has this charge starting at 2% for payrolls above $250,000 and increase to a maximum of 8% for payrolls above $400,000. These revenues will go to offset the cost of coverage for individuals purchasing insurance through the exchange. Small businesses that opt to offer insurance will receive tax credits to offset the cost of insurance.
Question: What does this bill do to stop fraud and abuse in Medicare?
Answer: This bill strengthens existing compliance and enforcement tools for Medicare, increases funding to support these efforts and creates new, tougher penalties for individuals who submit false claims or applications to Medicare. The Congressional Budget Office (CBO) has estimated that every $1 we invest in fighting waste, fraud and abuse will yield $1.75 in savings.
Question: Can our nation afford healthcare reform?
Answer: The truth is that the rising cost of healthcare for all Americans is a problem that will not fix itself and that we can't afford to not address. Today, we spend one out of every $6 we earn on healthcare. If we don't take action to slow the increase in costs, within a decade we will spend one out of every $5 on healthcare, and within 30 years this will rise to one in every $3. These facts make it clear, the longer we wait, the more it will cost to fix our broken healthcare system.
Question: How much will this bill cost?
Answer: There is no question that there will be significant costs to implement this legislation. The CBO's latest estimate puts the price tag at $1.042 trillion over ten years. Here is how we are going to pay for the bill. First, we are going to address inefficiencies in Medicare and Medicaid and crack down on fraud, waste and abuse in these programs to save $465 billion over the next ten years. Second, we will need to raise $583 billion in revenues to cover the rest of the cost. The Ways and Means Committee proposes to do this through a surcharge on the wealthiest 1.2% of income earners, who have enjoyed a tremendous advantage for the last eight years because of the Bush tax cuts (the average reduction in federal taxes for the top 1% in these tax cuts was $44,622). The Senate is considering other ways to raise these funds, and it is unclear how this issue will be dealt with in the final bill.
Question: Will this plan lead to rationing of healthcare? Will Congress be legislating what care my doctor can or must give me?
Answer: No. I believe that medical decisions should be left between patients and their doctors. Section 1401 explicitly forbids any studies or research called for in H.R. 3200 from being used to either mandate or deny care to a patient in any public or private plan. This research will gather data about what procedures are most effective to give doctors more information to consider when treating patients, not to replace your doctor's judgment with that of a bureaucrat from a private insurer or the government. The bill protects the ability of doctors to do what they think is necessary to help their patients without having to constantly worry about whether they will be reimbursed by an insurance company, which is why this bill has earned the strong support of the American Medical Association.
Question: Why is this bill being "rushed" through Congress?
Answer: Universal healthcare was first proposed by Teddy Roosevelt in 1912. President Harry Truman called for it in 1945. Former Representative John Dingell Sr. introduced a bill to provide universal healthcare in 1947 and his son, Representative John Dingell Jr., has reintroduced a bill every Congress since 1955. So, this is not a new issue and it was supported by both President Obama and Senator McCain in the November presidential election. There have been over 40 congressional hearings on healthcare reform since January. This particular legislation has been crafted, reviewed and revised repeatedly since the 111th Congress began, and it has been changed to reflect the considerable input from those in the healthcare community, members on both sides of the aisle and constituents. This bill is not being rushed - it is long overdue.
Sincerely,
MIKE THOMPSON
Member of Congress
http://www.mikethompson.house.gov
Dear Constituent:
I have a keen interest in healthcare, both as an individual and as a public servant. My wife Jan is a full-time nurse practitioner in our district and was a hospice nurse for years. I've had government sponsored healthcare in the Army - both here and overseas - and private healthcare with Kaiser Permanente and Blue Cross Blue Shield. Over the years, as a State Senator and U.S. Representative, I've talked with thousands of Northern Californians at length about the times when healthcare has been a blessing and, unfortunately, when it's failed them.
<>
I first ran for office in 1990, and a big part of that decision was because of the challenges of healthcare policy and its importance. This issue has remained in the forefront of my attention ever since. In the State Senate, I passed legislation that required all group healthcare plans to provide preventive healthcare to children, improved healthcare policies in rural areas and supported the development of telemedicine. Since arriving in the House of Representatives, I continued this work by enacting legislation that waives co-pays for colonoscopies and mammograms for Medicare beneficiaries, helps doctors who are called away to service in the reserves or the National Guard, expands telehealth technology, reverses harmful cuts to Medicare reimbursement rates for physicians, promotes funding for rural clinics and addresses unfair geographic reimbursement policies that consistently underpay providers in our district. <>
Unfortunately, many problems like rising premiums, shortages of skilled healthcare workers and a deteriorating long-term fiscal outlook for programs like Medicare have grown worse. These issues are far larger, more complex and more pervasive than almost any others our nation faces. It is no surprise that they have also drawn the most passionate responses. <>
Some argue that any type of reform would lead to socialism, but the majority of constituents I've heard from want Congress to lower costs, provide access for everyone and improve the quality of care. Most opinions are heartfelt, but a few are startling, such as the writers who want to reject any government involvement in healthcare because it's "socialist" while they themselves are receiving healthcare through Medicare or the Veterans Administration. However, almost every person I talk to or hear from agrees - the current healthcare system needs to be fixed. <>
While I am a strong proponent of healthcare reform, we need to make sure that we do this right. As you no doubt know, our current healthcare system is not sustainable. In the last 15 years, healthcare spending has jumped 145% to over $2.24 trillion. This is the equivalence of one in every $6 we earn going for healthcare. At current rates, within a decade that figure is expected to rise to one in $5, and within 30 years it will be one out of every $3. Right now, this system is failing us all; from those who can't get insurance because of a pre-existing condition to the families that have coverage but are finding it harder and harder to afford their rising premiums and deductibles. We are on an unsustainable path and most Americans want this corrected.
The House of Representatives is now considering the America's Affordable Health Choices Act (H.R. 3200), which presents comprehensive solutions to the healthcare challenges faced by all Americans. This bill includes many of my priorities, such as:
o Better healthcare for everyone by requiring all plans to meet minimum benefits standards, prohibiting denials of coverage based on pre-existing conditions and eliminating co-payments for preventive care visits to a doctor;
o Strengthening Medicare by increasing reimbursement rates for Medicare providers to allow them to continue seeing Medicare patients and closing the "donut" hole in prescription coverage for Medicare Part D;
o Real choice in a health insurance marketplace where consumers can compare different plans, including a public plan option, while still retaining the freedom to keep their current doctor, hospital and plan if they choose;
o Ensuring access to healthcare in rural areas by providing a reimbursement increase to primary care physicians practicing in these communities and expanding telemedicine services to make specialized care available for patients in underserved areas.
As a member of the Ways and Means Committee, I helped write parts of this bill, and I know that there is a lot in the bill that will go far toward improving our system. Although the full House of Representatives will not consider H.R. 3200 until September, I voted for this important legislation when it was considered by the Ways and Means Committee on July 17. We needed to advance this bill so that we can continue the work of crafting a comprehensive plan that will fix our healthcare system.
<> However, it is important to remember that this is the beginning of the process, and there is much work that remains to be done in both houses of Congress before we will reach a final bill. Nevertheless, there is wide agreement that the final version must satisfy these principles:
o Reduce the long-term growth of healthcare costs;
o Provide a choice of doctors and health plans;
o Improve quality of care and invest in prevention and wellness; and,
o Ensure affordable healthcare for all Americans.
Currently there are five bills in Congress to reform healthcare, three in the House and two in the Senate. From these, members of the House and Senate will reconcile differences, make improvements and come up with an even better bill. I think we have a long way to go before we are where we need to be, but H.R. 3200 is an important first step.
<> Healthcare touches all of our lives in a very personal way. I absolutely understand why so many Americans are concerned about the effectiveness and cost of healthcare. That's why it's so important that you judge the facts of this bill for yourself, particularly when there's been much disinformation. I have attached answers to the most common questions my office has been receiving for your review. Additionally, you can go to the Ways and Means Committee website (waysandmeans.house.gov) to read the bill in its entirety as well as a section-by-section summary. I will continue to update you as this important legislation progresses.
Question: Has Congressman Thompson read the bill?
Answer: I have read and was involved in drafting the bill I voted on. For weeks before the introduction of H.R. 3200, members of the Ways and Means Committee, myself included, met daily to go through the bill line by line and section by section. As a group, we spent 86 hours going over this legislation.
Question: Will health reform force all Americans out of their private insurance plans and into a one-size-fits-all government plan?
Answer: No. H.R. 3200 builds on the current system of employer-based coverage, it doesn't replace it. If you are happy with your current plan, you can keep it. H.R. 3200 includes a public plan that individuals will have the option of purchasing, along with a variety of other private plans. This public plan will be required to be financially self-sustaining, as private plans are, covering its costs through premiums and co-pays.
Question: Does page 16 of the bill require me to join the public plan if I lose my private insurance coverage?
Answer: No one will be required to join the public plan. If you lose your insurance, you will be able to shop for a new plan at an online exchange that includes information on all insurance options. This exchange will bring together information that is currently scattered giving consumers the opportunity to quickly and effectively compare plans to make informed decisions about what coverage works best for them. The provision on page 16 merely requires individuals joining a private insurance plan after 2013 to do so through the exchange.
Question: Are Members of Congress exempt from changes that are being proposed for the rest of the country?
Answer: No. Members of Congress receive the same healthcare options as other federal employees, with a choice of plans from private insurers that vary by benefits, premiums and co-pays. This legislation would affect federal employees in the same ways that it affects everyone else who gets their health insurance through their employer.
Question: Does this bill cover illegal immigrants?
Answer: No. Section 246 of H.R. 3200 explicitly prohibits the payment of affordability credits designed to help low and moderate incomes families purchase insurance to anyone who is not lawfully present in the United States.
Question: Does this bill require seniors to attend mandatory counseling sessions on euthanasia?
Answer: No. H.R. 3200 states that Medicare will reimburse doctors and nurse practitioners for a counseling session with Medicare beneficiaries regarding advanced care planning. This consultation includes a discussion of laws and options regarding living wills, the roles and responsibilities of a health care proxy and other planning resources that may be available for the individual. These consultations are strictly voluntary.
Question: Will all small businesses be forced to provide coverage to their employees?
Answer: This bill exempts small businesses with a payroll of less than $250,000 from the requirement to provide health insurance for their workers. Businesses with payrolls above $250,000 that do not provide coverage will be assessed a charge that will gradually increase with the size of their payroll. The current version of the bill has this charge starting at 2% for payrolls above $250,000 and increase to a maximum of 8% for payrolls above $400,000. These revenues will go to offset the cost of coverage for individuals purchasing insurance through the exchange. Small businesses that opt to offer insurance will receive tax credits to offset the cost of insurance.
Question: What does this bill do to stop fraud and abuse in Medicare?
Answer: This bill strengthens existing compliance and enforcement tools for Medicare, increases funding to support these efforts and creates new, tougher penalties for individuals who submit false claims or applications to Medicare. The Congressional Budget Office (CBO) has estimated that every $1 we invest in fighting waste, fraud and abuse will yield $1.75 in savings.
Question: Can our nation afford healthcare reform?
Answer: The truth is that the rising cost of healthcare for all Americans is a problem that will not fix itself and that we can't afford to not address. Today, we spend one out of every $6 we earn on healthcare. If we don't take action to slow the increase in costs, within a decade we will spend one out of every $5 on healthcare, and within 30 years this will rise to one in every $3. These facts make it clear, the longer we wait, the more it will cost to fix our broken healthcare system.
Question: How much will this bill cost?
Answer: There is no question that there will be significant costs to implement this legislation. The CBO's latest estimate puts the price tag at $1.042 trillion over ten years. Here is how we are going to pay for the bill. First, we are going to address inefficiencies in Medicare and Medicaid and crack down on fraud, waste and abuse in these programs to save $465 billion over the next ten years. Second, we will need to raise $583 billion in revenues to cover the rest of the cost. The Ways and Means Committee proposes to do this through a surcharge on the wealthiest 1.2% of income earners, who have enjoyed a tremendous advantage for the last eight years because of the Bush tax cuts (the average reduction in federal taxes for the top 1% in these tax cuts was $44,622). The Senate is considering other ways to raise these funds, and it is unclear how this issue will be dealt with in the final bill.
Question: Will this plan lead to rationing of healthcare? Will Congress be legislating what care my doctor can or must give me?
Answer: No. I believe that medical decisions should be left between patients and their doctors. Section 1401 explicitly forbids any studies or research called for in H.R. 3200 from being used to either mandate or deny care to a patient in any public or private plan. This research will gather data about what procedures are most effective to give doctors more information to consider when treating patients, not to replace your doctor's judgment with that of a bureaucrat from a private insurer or the government. The bill protects the ability of doctors to do what they think is necessary to help their patients without having to constantly worry about whether they will be reimbursed by an insurance company, which is why this bill has earned the strong support of the American Medical Association.
Question: Why is this bill being "rushed" through Congress?
Answer: Universal healthcare was first proposed by Teddy Roosevelt in 1912. President Harry Truman called for it in 1945. Former Representative John Dingell Sr. introduced a bill to provide universal healthcare in 1947 and his son, Representative John Dingell Jr., has reintroduced a bill every Congress since 1955. So, this is not a new issue and it was supported by both President Obama and Senator McCain in the November presidential election. There have been over 40 congressional hearings on healthcare reform since January. This particular legislation has been crafted, reviewed and revised repeatedly since the 111th Congress began, and it has been changed to reflect the considerable input from those in the healthcare community, members on both sides of the aisle and constituents. This bill is not being rushed - it is long overdue.
Sincerely,
MIKE THOMPSON
Member of Congress
http://www.mikethompson.house.gov
Monday, September 7, 2009
President addresses health care
On Wednesday, President Obama will address our country on the issue of health care. It is incumbent upon all of us who have anything to say about health care in the United States to share our thoughts and concerns with the President. If he doesn't hear from us there is no way he will ever know how we feel about this extremely important issue. Health Care effects all of us. You can email president Obama at the following address.
http://capwiz.com/politicsol/mail/?id=3181&lvl=F&chamber=P
http://capwiz.com/politicsol/mail/?id=3181&lvl=F&chamber=P
Thursday, September 3, 2009
$1.2 Trillion waste in health care spending report
As mentioned in earlier Blog, Price Waterhouse Cooper published a report revealing $1.2 trillion waste in health care spending. Following is a link to the report. It is very informative and easy to read. Enjoy
http://www.hasnet.us/uploads/PWC_The_Price_of_Excess_Exec_Sum_Exhibit3.pdf
http://www.hasnet.us/uploads/PWC_The_Price_of_Excess_Exec_Sum_Exhibit3.pdf
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